SGLT1-SGLT2 Inhibitor

Sodium-glucose cotransporters 1 and 2 (SGLT1/SGLT2) inhibitors are medications used in the treatment of patients with heart failure or high cardiovascular risk factors such as type II diabetes mellitus or chronic kidney disease. SGLT1/SGLT2 inhibitors reduce the risk for hospitalization and cardiovascular death in adults with heart failure.

Sodium-glucose cotransporters are protein molecules that regulate the transport of glucose and sodium across cell membranes. SGLT1 is primarily responsible for the absorption of glucose from the intestines from dietary intake, while SGLT2 mediates the reabsorption of glucose from the kidneys back into circulation.

SGLT1/SGLT2 inhibitors interfere with the function of both SGLT1 and SGLT2, reducing glucose and sodium absorption in the intestines as well as reabsorption in the kidneys. This increases fecal and urinary excretion of glucose and sodium, and reduces their circulating levels, which is thought to lower the preload and afterload in the heart and downregulate the activity of the sympathetic nervous system.

The reduced intestinal absorption of sodium and glucose likely contributes to diarrhea, a major side effect, and urinary glucose excretion can promote urinary infections. Currently, the first and only medication in the SGLT1/SGLT2 inhibitor class is sotagliflozin, approved by the FDA in May 2023. Sotagliflozin is expected to be commercially available in June 2023.

SGLT1/SGLT2 inhibitors are oral tablets used to reduce the risk of urgent heart failure visits, hospitalization for heart failure, and cardiovascular death in adults with:

• Heart failure, or
• Cardiovascular risk factors such as type II diabetes mellitus or chronic kidney disease

Side effects of SGLT1/SGLT2 inhibitors may include the following:

• Urinary tract infection
• Depletion of blood volume (hypovolemia)
• Low blood glucose levels (hypoglycemia)
• Diarrhea
• Dizziness
• Genitourinary fungal infection
• Decrease in eGFR
• Increase in blood creatinine level
• Urinary tract infection with sepsis
• Kidney inflammation due to urinary infection (pyelonephritis)
• Necrotizing fasciitis of the perineum (Fournier’s gangrene), a type of serious bacterial infection that spreads rapidly
• Ketoacidosis, a condition with excessive accumulation of blood acids known as ketones

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of SGLT1/SGLT2 inhibitors include:

• Inpefa
• sotagliflozin