SGLT2 Inhibitors

Question 1

What is the mechanism of action of SGLT2 and where does it work

Answer 1

normally Na+ and glucose are reabsorbed back into blood. SGLT2 inhibitors inhibit Na+ and glucose from being reabsorbed –> so it’s excreted in urine = lower blood glucose. Works in the proximal convoluted tubule.

Question 2

What are the major side effects of SGLT2 inhibitors

Answer 2

1) glucosuria –> DKA (volume depletion as water follows glucose out in urine)
2) UTIs
3) weight loss

Question 3

What are the 2 SGLT2 medications that have CVD protection. Why?

Answer 3

empagliflozin and canagliflozin, because they are diuretics

Question 4

What is the 2 major contraindication to canagliflozin ? Which study was one of the contraindications shown in ?

Answer 4

1) CANVAS trial showed fractures and amputations

2) CKD eGFR <30

Question 5

What is the starting and max dose of empagliflozin and canagliflozin

Answer 5

empagliflozin
start: 10mg, max: 25mg

canagliflozin
start: 100mg, max: 300mg