TABLE 4.

Contraindications and Cautions for SGLT2 Inhibitors

Contraindications	Cautions*
■ History of serious hyper-sensitivity reaction to drug ■ Severe renal impairment, ESRD, or dialysis†	■ May cause intravascular volume contraction, particularly in patients with renal impairment or low systolic blood pressure, those on diuretics, or the elderly
	■ Increased incidence of bone fractures reported with canagliflozin
	■ Hypoglycemia risk increased with insulin and insulin secretagogues (e.g., sulfonylureas); a lower dose of insulin or the insulin secretagogue may be required
	■ Increased risk of mycotic genital infections.
	■ Euglycemic ketoacidosis in vulnerable patients
	■ History of prior amputation, severe peripheral vascular disease, neuropathy, or diabetic foot ulcers. This caution is for canagliflozin and ertugliflozin. No increased risk of amputation has been seen for empagliflozin or dapagliflozin to date.
	■ History of osteoporosis. This caution is for canagliflozin.

^*SGLT2 inhibitors are not for the treatment of type 1 diabetes.

^†SGLT2 inhibitors have shown benefit for CV event reduction down to eGFR of 30 mL/min/m²

ESRD = end-stage renal disease; SGLT2 = sodium-glucose cotransporter 2.