Names and pronunciation
(er-too-gli-floe′zin/met-for′min) Segluromet
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Drug reference
(er-too-gli-floe′zin/met-for′min) Segluromet
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Func. class.: Antidiabetics
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Chem. class.: Sodium-glucose cotransporter 2 (SGLT2) inhibitor
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ACTION: An inhibitor of sodium-glucose co- transporter 2 (SGLT2), the transporter responsible for reabsorbing most of the glucose filtered by the tubular lumen in the kidney Uses: Treatment of type 2 diabetes melli- tus in combination with diet and exercise Contraindications: Hypersensitivity, se- vere renal disease
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Black Box Warning: Lactic acidosis Precautions: Adrenal insufficiency, bala- nitis, breast feeding, burns, children, dehydration, diabetic ketoacidosis, dialy- sis, fever, geriatric, hepatic disease, hyper- cholesterolemia, hypercortisolism, hyper- glycemia, hyperthyroidism, hypoglycemia, hypotension, hypothyroidism, hypovole- mia, infants, infection, lower limb amputa- tion, malnutrition, pituitary insufficiency, pregnancy, pyelonephritis, renal disease, surgery, tissue necrosis, trauma, type 1 diabetes mellitus, UTI, vaginitis Black Box Warning: Lactic acidosis: hy- pothermia, dysrrhythmias, death Lower limb amputation: Increased risk of amputation; monitor wound and feet closely for complications • Pregnancy/breastfeeding: identify whether pregnancy is planned or sus- pected or if breastfeeding Black Box Warning: Lactic acidosis: to discontinue immediately if symptoms of lactic acidosis occur: myalgia, change in heart rhythm, feeling cold, hyperventila- tion, report immediately
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SIDE EFFECTS MS: Back pain GU: Diuresis, dysuria, increased urinary frequency/urgency, nocturia, polyuria, renal failure, vaginitis, cystitis, dehydration CNS: Headache syncope META: Hypercholesterolemia, hyperlip- idemia, hyperphosphatemia, hypoglyce- mia, diabetic ketoacidosis CV: Hypotension, hypovolemia MISC: Infection, lower limb amputation, necrotizing fasciitis, orthostatic hypoten- sion, pharyngitis, polydipsia, tissue necro- sis, weight loss, candidiasis, lactic acidosis
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INTERACTIONS Increase: hypoglycemia—insulin, anti- diabetes Increase: urinary injury—ACE inhibi- tors, diuretics, NSAIDs NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Adults: PO Individualize the starting dose. Take ertugliflozin/metformin bid with meals. Max: ertugliflozin 7.5 mg/metfor- min 1000 mg bid with meals. Those tak- ing ertuglifloxacin: Initiate at current dose of ertugliflozin in combination with metformin 500 mg given bid with meals; increase gradually to reduce the GI side effects due to metformin. Those taking metformin: Initiate at ertugliflozin 2.5 mg/ metformin (either 500 mg or 1000 mg) given bid with meals, using whichever met- formin dose is the same or closest to the current metformin dose. Those taking both: Switch to the combination product using the same daily doses of each compo- nent, divided and given bid with meals
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Available forms: Tablets ertugliflozin 2.5 mg and metformin hydrochloride 500 mg, ertugliflozin 7.5 mg and metfor- min hydrochloride 500 mg, ertugliflozin 2.5 mg and metformin hydrochloride 1000 mg, ertugliflozin 7.5 mg and met- E formin hydrochloride 1000 mg
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Administer: • Administer daily in the morning, with or without food
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Assess: • Hypoglycemia (weakness, hunger, dizziness, tremors, anxiety, tachycar- dia, sweating), hyperglycemia; even though product does not cause hypo- glycemia, if patient is on sulfonylureas or insulin, hypoglycemia may be addi- tive; if hypoglycemia occurs, treat with dextrose, or, if severe, with IV gluca- gon • Ketoacidosis: monitor for increased ketone levels; may occur with any glucose level, more common in those with severe illnesses • Volume depletion: monitor for ortho- static hypotension, weakness, dizziness; may occur after beginning treatment; correct volume depletion before starting treatment • For stress, surgery, or other trauma that may require a change in dose • A1c q3mo; monitor serum glucose 1 hr PP throughout treatment; serum cho- lesterol, serum creatinine/BUN, serum electrolytes • Bone fractures: monitor bone den- sity, other conditions that may lead to bone fractures; fractures may occur within 3 mo of starting therapy • Renal impairment: monitor more frequently in those with renal disease; increased creatinine, eGFR may be de- creased, BUN may occur
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Evaluate: • Therapeutic response: improved signs/ symptoms of diabetes mellitus (decreased polyuria, polydipsia, polyphagia); clear sensorium, absence of dizziness, stable gait
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Patient and caregiver information: • The symptoms of hypo/hyperglycemia, what to do about each • That medication must be taken as prescribed; explain consequences of discontinuing medication abruptly; that insulin may need to be used for stress, including trauma, fever, surgery; to take as soon as remembered if dose is missed unless close to next dose, then skip and take at next scheduled dose, do not double • To avoid OTC medications and herbal supplements unless discussed with health care professional • That diabetes is a lifelong illness; that the diet and exercise regimen must be followed; that this product is not a cure • To carry emergency ID and glucose source • That blood glucose monitoring is re- quired to assess product effect • Hypersensitivity: to notify prescriber immediately of itching, hives, rash, swell- ing of face/lips Lower limb amputation risk: Inspect feet; monitor for new ulcerations, wounds; edu- cate about foot care • Ketoacidosis: to notify prescriber immediately of nausea, vomiting, lack of appetite, sleepiness, difficulty breathing • Yeast infections (women/men): That yeast infections can occur with this product (women, vaginal; men, penile); to report discharge, itching, swelling • Pregnancy/breastfeeding: Not to breastfeed; to advise prescriber if preg- nancy is planned or suspected
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PHARMACOKINETICS Ertugliflozin: Onset unknown, peak 1-2 hr, duration unknown, half-life 18.5 hr Metformin: Onset unknown, peak 2-3 hr, duration unknown
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