Mechanism of Action: SGLT2 inhibitors block the reabsorption of glucose in the proximal tubule, increasing urinary glucose excretion (UGE) and lowering plasma glucose levels. They also have beneficial effects on blood pressure, body weight, and cardiovascular outcomes. –
Dosing:
Empagliflozin: 10–25 mg once daily (start at 10 mg, max 25 mg). –
Dapagliflozin: 5–10 mg once daily (start at 5 mg, max 10 mg). –
Canagliflozin: 100–300 mg once daily (start at 100 mg, max 300 mg;
dose reduction for eGFR 45–60 mL/min/1.73 m²). –
Ertugliflozin: 5–15 mg once daily (start at 5 mg, max 15 mg). –
Uses:Type 2 Diabetes Mellitus (T2DM): As monotherapy or add-on therapy to improve glycemic control. –
Cardiovascular Protection: Reduce risk of hospitalization for heart failure (HHF) and major adverse cardiovascular events (MACE) in high-risk patients (e.g., empagliflozin, dapagliflozin, canagliflozin). –
Chronic Kidney Disease (CKD): Slow progression in patients with T2DM and CKD (e.g., dapagliflozin, empagliflozin). –
Side Effects:Genitourinary Infections: Increased risk of urinary tract infections (UTIs) and genital mycotic infections (e.g., vulvovaginitis, balanitis) due to glucosuria. –
Volume Depletion: Hypotension, dizziness, and syncope (especially in elderly or volume-depleted patients). –
Diabetic Ketoacidosis (DKA): Risk of euglycemic DKA, particularly in T1DM or during stress (e.g., surgery, illness). –
Lower Limb Amputation: Rarely associated with canagliflozin (black box warning). –
Bone Fractures: Increased risk with canagliflozin (due to bone demineralization).