Table 4.

Adverse reactions to sodium glucose co-transporter 2 inhibitors^{9,11,12,19–21}

Adverse reaction	Frequency	Notes
Genital mycotic infections	Common / very common	Both male and female. Provide genital hygiene advice. Most initial cases can be treated with topical antifungals and won't recur. Consider reviewing therapy if recurrent infections.
Increased urination	Common	Increased frequency and/or increased volume.
Urinary tract infections	Common	In recent large trials, any increase in risk was small and non-significant.
Volume depletion side effects (thirst, postural dizziness, hypotension and dehydration)	Common/uncommon (varies with agent)	Caution in frail/elderly. Consider measuring blood pressure in lying and standing position in those at risk of fall and those on diuretics
Diabetic ketoacidosis	Rare: <1/1,000 in SmPC (between 0 and 2 additional events per 1,000 person-years in RCTs); real life events may be higher	Inform and advise patients and healthcare professionals about how to prevent diagnose and treat DKA
Amputation	Uncommon: event rate <1/100 in SmPC (between 0 and 3 additional events per 1,000 person-years in RCTs);a real-life events may be lower	Encourage routine preventative foot care; regular foot checking Advise patients to report wounds, discoloration or tender/painful feet Consider stopping therapy if significant foot problems arise (such as infection or skin ulcers)

^aExcess amputations were only seen in one study; subsequent studies with the same SGLT2 inhibitor and others have not confirmed a significant increase; any risk is likely to be very low. Necrotising fasciitis (Fournier's gangrene): post-marketing reports have been reported (six yellow card reports in >500,000 patient-years. Recent large trials have not shown any increase in risk. Patients should be advised to seek urgent medical attention if they experience fever/malaise along with pain, tenderness or redness in the genital or perineal area.²² DKA = diabetic ketoacidosis; SmPC = summary of product characteristics. Frequency: very common = ≥1/10; common = ≥1/100 to <1/10; uncommon = ≥1/1,000 to <1/100; rare = ≥1/10,000 to < 1/1,000.