Ertugliflozin and Liver Enzyme Elevations

Clinical Management

• When liver enzyme elevations occur with ertugliflozin, they typically resolve within 1-4 months after discontinuation of the medication 1
• For patients taking ertugliflozin who develop elevated liver enzymes, if liver enzymes increase to ≥3 times the upper limit of normal (ULN), holding ertugliflozin and repeating liver function tests within 48-72 hours is recommended 1
• The decision to continue or discontinue ertugliflozin due to liver enzyme elevations should be based on the magnitude of enzyme elevation, presence of symptoms suggesting liver injury, and availability of alternative glucose-lowering medications 1
• For patients who develop significant liver enzyme elevations on ertugliflozin, switching to a GLP-1 receptor agonist may be appropriate, especially in patients with reduced kidney function, such as eGFR <20 mL/min/1.73 m² 2
• The American Diabetes Association and other guideline societies may recommend considering alternative medications, such as GLP-1 receptor agonists, for patients with significant liver enzyme elevations on ertugliflozin, based on the strength of evidence from studies like those published in Mayo Clinic Proceedings 2