SGLT2 Inhibitors

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are oral medications that the FDA has approved for Type 2 diabetes and, in some cases, chronic kidney disease (CKD) and heart failure. They work by helping the body eliminate excess glucose and sodium through urination.

If you’re not sure if your medication is an SGLT2 inhibitor, look for a generic name ending in “-flozin.”

Not all SGLT2 Inhibitors are approved for all the same conditions. Some may be approved for different applications.

How SGLT2 Inhibitors Work

SGLT2 inhibitors stop a protein that usually moves sugar and salt from fluid in the kidneys back into the body. This protein is known as the sodium-glucose cotransporter 2 (SGLT2) protein, which explains its name.

When this protein is blocked, the body eliminates some excess sugar and salt through urine to lower their amounts in your blood. This lowers blood sugar levels for people with Type 2 diabetes and relaxes the kidneys for those with chronic kidney disease. This process can help reduce blood pressure and even result in some weight loss.

Studies indicate that kidney relaxation may also improve heart health, though the exact way SGLT2 inhibitors affect the heart isn’t fully understood.

SGLT2 inhibitors help balance sodium and glucose levels in the blood, leading the FDA to approve them as Type 2 diabetes, CKD and heart failure treatments. However, like all medicines, they come with some risks. If you are considering SGLT2 inhibitors, it’s essential to understand the key benefits, possible side effects and how to weigh the pros and cons with your doctor.

Benefits of SGLT2 Inhibitors

SGLT2 inhibitors have historically been best known as a Type 2 diabetes treatment, but they’re also FDA-approved for heart failure and CKD.

Risks and Side Effects of SGLT2 Inhibitors

While SGLT2 inhibitors offer significant benefits, they have side effects and risks.

Common side effects of SGLT2 inhibitors can include more frequent urination, low blood sugar, low blood pressure and urinary and genital infections. People with CKD may also see a short-lived decrease in kidney function while the body adjusts.

More rarely, people taking SGLT2 inhibitors experience significant health challenges. Key risks include diabetic ketoacidosis and lower limb amputations.

Risk-Benefit Considerations of SGLT2 Inhibitors

As with any medication, discussing SGLT2 inhibitors with your doctor before taking them is essential. These medications can help those with diabetes, CKD and heart failure. However, there are rare, serious side effects. For instance, Invokana may increase the risk of amputations, and canagliflozin can elevate the chance of diabetic ketoacidosis (DKA).

However, the benefits usually outweigh the risks, especially with regular monitoring by your healthcare provider.

According to the National Kidney Foundation, SGLT2 inhibitors may initially cause a slight decrease in kidney function, but this is a normal response. The medicine lowers pressure in the kidneys, giving them a break. Over time, this helps protect the kidneys and slows down damage, even though the first change in test results might seem concerning.

The U.S. Food and Drug Administration has carefully monitored SGLT2 inhibitors for safety. The agency has added significant warnings and updates to the drugs’ labels.

Though the medications are part of the same drug class, the warnings can vary by brand.

Drugwatch is not currently aware of any attorneys accepting SGLT2 lawsuits. However, more than 1,200 people filed SGLT2 lawsuits in the 2010s.

Several SGLT2 lawsuits were combined into two multidistrict litigations (MDLs). An MDL allows a federal panel to consolidate several similar lawsuits into one litigation in a single federal court, simplifying the legal process. One MDL targeted Invokana side effects. The other targeted side effects from Farxiga.

The judge presiding over the Invokana MDL closed the litigation in 2023 after attorneys for both sides resolved more than 1,200 lawsuits. The judge in the Farxiga MDL closed 67 cases in 2020. One remaining case was returned to the court where it was initially filed.

If you suspect that you or someone you know is experiencing problems from SGLT2 inhibitors, act promptly to minimize risks and support public health.

Seek immediate medical attention if you have signs of infection or DKA, as delays can lead to serious issues. Report any side effects, even if you’re unsure of the cause, as documentation can aid in wider medical and legal matters.

When to Seek Immediate Medical Attention

You should seek immediate medical attention if you experience symptoms of severe SGLT2 inhibitor side effects such as DKA, Fournier’s gangrene, other severe infections and any limb pain or ulcers.

Consult your doctor or other health care provider before stopping treatment and let them know immediately if you experience any of these symptoms while taking an SGLT2 inhibitor.

Of course, you should have regular checkups to monitor your health while on an SGLT2 inhibitor and contact your provider if you have questions or concerns.

Report Severe Side Effects to the FDA

To submit a report, use the FDA MedWatch portal online or call 1-800-332-1088 for a reporting form. Your submission should include your demographics (age, sex, medical condition, etc.), medication, dosage and duration, and a description of the adverse event and any outcomes.

Reporting is vital, as the FDA uses this information to update safety warnings, such as the 2017 amputation warning for Invokana, and to inform prescribing guidelines through post-market surveillance.

Document Your Injuries for Long-Term Protection

It’s essential to keep a record of your symptoms. Create a journal where you record the date each symptom began, its severity and how it progressed over time. Make sure to write down any medications you were taking and their dosages, as well as details about doctor visits and treatments you received.

This can help your doctor understand what’s happening and plan the best treatment.

It’s also a good idea to get copies of your medical records. This includes essential lab results, such as blood sugar levels and scans related to your health issues. This information can be invaluable if you must report a problem to health authorities or are considering legal action.