SGLT2 Inhibitor Cross-Sensitivity and Adverse Effects
Pharmacological Characteristics
- Different SGLT2 inhibitors have varying degrees of selectivity for SGLT2 versus SGLT1 receptors, with dapagliflozin, empagliflozin, and ertugliflozin being the most selective inhibitors for SGLT2 1
- Canagliflozin has greater potential for inhibiting SGLT1 receptors compared to other agents, while sotagliflozin is considered a "dual SGLT1/SGLT2 inhibitor" with the highest affinity for SGLT1 receptors 1
Adverse Effects
- Volume depletion effects, including those in patients with renal impairment, elderly patients, or those on diuretics, are a concern with SGLT2 inhibitors, as recommended by the American College of Cardiology 2, 3
- Euglycemic ketoacidosis risk exists with all agents in this class, as noted by the American College of Cardiology 2, 3
- Canagliflozin has been associated with increased risk of bone fractures, lower limb amputations, and osteoporosis concerns, as reported by the American College of Cardiology 2, 3
- No increased risk of amputation has been observed with empagliflozin or dapagliflozin to date, according to the American College of Cardiology 2, 3