Table 1.
Summary of the approved doses, indications, benefits, and adverse effects of the most commonly used SGLT-2 inhibitors.
| Generic Name (Brand Name) | Dose (mg) Based on eGFR |
Indications | Beneficial Effects | Adverse Effects |
|---|---|---|---|---|
| Canagliflozin (Invokana) [22] |
eGFR > 60: 100 mg once daily and if tolerated, may increase to 300 mg once daily for additional glycemic control eGFR 30–60: 100 mg once daily eGFR < 30: initiation is not recommended, although patients with albuminuria (>300 mg/day) may continue 100 mg once daily to reduce the risk of ESRD, CV death, and hospitalization for HF On dialysis: contraindicated |
Adjunct to diet and exercise Glycemic control in T2DM Heart attacks, stroke DKD CKD |
↓Blood sugar levels ↓Body weight ↓BP ↓Risk of CV events in high-risk patients with T2DM ↓Risk of kidney disease progression |
↑Risk of mycotic yeast infections, UTIs ↑Dehydration ↑Hypotension ↑Ketoacidosis ↑Risk of fractures ↑Risk of amputations in patients with PAD ↑AKI |
| Dapagliflozin (Farxiga) [23] |
eGFR > 45: (a) initiation with 5 mg once daily if for glycemic control only. If tolerated, may increase to 10 mg once daily for additional glycemic control. (b) if other indications: initiation with 10 mg once daily eGFR 25–45: 10 mg once daily eGFR < 25: initiation is not recommended, but patients may continue 10 mg once daily to reduce the risk of eGFR decline, ESRD, CV death and hospitalization for HF On dialysis: contraindicated |
Adjunct to diet and exercise Glycemic control in T2DM Chronic HFrEF ,CKD |
↓Blood sugar levels ↓Body weight ↓BP ↓Risk of CV events in high-risk patients with T2DM ↓Risk of kidney disease progression ↓Risk of HF hospitalizations ↓Reduces MAFLD ↑Improves long-term glycemic control |
↑Risk of mycotic yeast infections, UTIs ↑Dehydration ↑Hypotension ↑Ketoacidosis ↑Risk of fractures ↑Risk of amputations in patients with PAD ↑AKI |
| Empagliflozin (Jardiance) [24] |
eGFR ≥ 30: initiation with 10 mg once daily. If tolerated, may increase to 25 mg once daily for additional glycemic control eGFR < 30: patients with T2DM and CV disease: no specific recommendations (lack of substantial evidence) eGFR < 20: patients with HF: no specific recommendations (lack of substantial evidence) On dialysis: contraindicated |
Adjunct to diet and exercise Glycemic control in T2DM Chronic HFrEF CKD |
↓Blood sugar levels ↓Body weight ↓BP ↓Risk of HF hospitalizations ↓CV mortality ↓Albuminuria ↑Improves arterial stiffness and endothelial function |
↑Risk of mycotic yeast infections, UTIs ↑Dehydration ↑Hypotension ↑Ketoacidosis ↑Risk of fractures ↑Risk of hyperkalemia ↑AKI |
| Ertugliflozin (Steglatro) [25] |
eGFR ≥ 45: (a) initiation with 5 mg once daily. If tolerated, may increase to 15 mg once daily for additional glycemic control eGFR < 45: it is not recommended On dialysis: contraindicated |
Adjunct to diet and exercise Glycemic control in T2DM |
↓Blood sugar levels ↓Body weight ↓BP |
↑Risk of mycotic yeast infections, UTIs ↑Dehydration ↑Ketoacidosis |
Abbreviations: ↓—decrease; ↑—increase; eGFR—estimated glomerular filtration rate; ESRD—end-stage renal disease; BP—blood pressure; CV—cardiovascular; T2DM—type 2 diabetes mellitus; DKD—diabetic kidney disease; CKD—chronic kidney disease; UTIs—urinary tract infections; PAD—peripheral artery disease; AKI—acute kidney injury; HF—heart failure; MAFLD—metabolic-associated fatty liver disease; HFrEF—heart failure with reduced ejection fraction.