Known brand names include Jardiance.
A once-daily SGLT2 inhibitor pill that makes the kidneys pass extra sugar into the urine. It lowers blood sugar in type 2 diabetes and, in adults, lowers the risk of heart failure hospitalization, cardiovascular death, and kidney decline in heart failure and chronic kidney disease.
Labeled use. Reduces cardiovascular death and heart failure hospitalization in adults.
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Labeled use. Glycemic control from age 10, and reduction of cardiovascular death with established cardiovascular disease.
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Labeled use. Adults at risk of progression; not for polycystic kidney disease or recent IV immunosuppression.
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Preferred add-on to metformin, or used regardless of glucose control, in type 2 diabetes with heart failure, chronic kidney disease, or established cardiovascular disease. It is also a core heart failure therapy with or without diabetes. It has a low hypoglycemia risk on its own and modest weight loss. Avoid with recurrent genital infections, frequent volume depletion, or high ketoacidosis risk.
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Inhibits SGLT2, the main transporter that reabsorbs filtered glucose, which lowers the renal glucose threshold and increases urinary glucose excretion. It also reduces sodium reabsorption and raises distal sodium delivery, which may increase tubuloglomerular feedback, lower intraglomerular pressure, reduce cardiac preload and afterload, and downregulate sympathetic activity. Peak levels come about 1.5 hours after a dose and the half-life is about 12.4 hours.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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Not recommended for glycemic control below an eGFR of 30, where its glucose-lowering effect fades. Trials for heart failure and chronic kidney disease enrolled patients with eGFR down to 20; risks of volume depletion, kidney injury, and UTI rise as renal function falls.
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No specific antidote. For overdose, contact Poison Help or a medical toxicologist. Removal by hemodialysis has not been studied.
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Not recommended in the second and third trimesters, based on kidney effects in animal studies during the period that matches late human kidney development. Human data are too limited to judge the risk of birth defects or miscarriage. Poorly controlled diabetes itself carries risks for mother and baby.
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Not recommended while breastfeeding, because the infant kidney keeps maturing in the first 2 years and the drug concentrates in rat milk.
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Established for glycemic control in type 2 diabetes from age 10; hypoglycemia was more common in children, with or without insulin. Not established under 10 or for the heart failure and kidney indications.
No overall differences in the heart failure and kidney trials. In older adults with diabetes, volume depletion and urinary tract infections were more frequent at 75 and older, and glucose lowering is weaker with renal impairment.
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