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News: Prescriber's Letter October 2014

Jardiance (jar-DEE-ans, empagliflozin) will be the third SGLT2 inhibitor...after Invokana (canagliflozin) and Farxiga (dapagliflozin).
These “flozins” increase glucose excretion by inhibiting sodium-glucose co-transporter 2 (SGLT2) in the kidney.
They all lower A1C by about 0.7% to 1%...reduce weight by 4 to 7 pounds...lower systolic BP by 3 to 5 mmHg...and rarely cause hypoglycemia.
But these drugs have downsides.
They cost about $10/day...similar to Januvia (sitagliptin).
They may cause genital yeast infections...especially in women. For example, Jardiance 10 mg/day causes 1 more yeast infection for every 26 women or 38 men treated for about 6 months. SGLT2 inhibitors may also lead to lower urinary tract infections...but these are less common.
They also raise LDL by about 4 to 8 mg/dL.
Avoid Farxiga if eGFR is less than 60 mL/min...and avoid Invokana or Jardiance if eGFR is less than 45 mL/min.
Consider SGLT2 inhibitors to be a second- or third-line option... along with gliptins, glitazones, GLP-1 agonists, sulfonylureas, etc.
Advise patients to take SGLT2 inhibitors in the morning...due to their diuretic effect.

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