Names and pronunciation
(er-too-gli-floe′-zin) Steglatro
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Drug reference
(er-too-gli-floe′-zin) Steglatro
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Func. class.: Antidiabetic
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Chem. class.: Sodium-glucose cotrans- porter 2 inhibitors
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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
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USES: For the treatment of type 2 dia- betes mellitus
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CONTRAINDICATIONS Hypersensitivity, severe renal disease Precautions: Adrenal insufficiency, bal- anitis, breastfeeding, burns, children, dehydration, diabetic ketoacidosis, dialy- sis, fever, geriatric, hepatic disease, hypercholesterolemia, hypercortisolism, hyperglycemia, hyperthyroidism, hypo- glycemia, hypotension, hypothyroidism, hypovolemia, infants, infection, lower limb amputation, malnutrition, pituitary insufficiency, pregnancy, pyelonephritis, renal disease, surgery, tissue necrosis, trauma, type 1 diabetes mellitus, UTI, vaginitis
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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, hyperlipid- emia, hyperphosphatemia, hypoglyce- mia, diabetic ketoacidosis CV: Hypotension, hypovolemia, ortho- static hypotension MISC: Infection, lower limb amputation, necrotizing fasciitis, orthostatic hypoten- sion, pharyngitis, polydipsia, tissue necrosis, weight loss, candidiasis
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INTERACTIONS Increase: hypoglycemia—insulin, anti- diabetes Increase: urinary injury—ACE inhibi- tors, diuretics, NSAIDs, ARBs Drug/Lab Test Increase: LDL, cholesterol, Hb, serum creatinine, phosphate Interference: Urine glucose, 1,5-AG assay NURSING CONSIDERATIONS
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Black Box Warning: Lower limb am- putation: increased risk of amputation; monitor wound and feet closely for com- plications • Pregnancy/breastfeeding: identify whether pregnancy is planned or sus- pected or if breastfeeding Black Box Warning: Lower limb ampu- tation risk: inspect feet; monitor for new ulcerations, wounds; educate 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, pe- nile); to report discharge, itching, swelling • Pregnancy/breastfeeding: not to breastfeed; to advise prescriber if preg- nancy is planned or suspected
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DOSAGE AND ROUTES For type 2 diabetes mellitus in combination with diet and exercise • Adult: PO 5 mg/day in the morning, with or without food; max 15 mg/day Renal dose • Adult: PO CCr 30-60 mL/min/ 1.73 m2, avoid use
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Available forms: Tablets 5 mg, 15 mg
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Administer: • Administer daily in the morning, with or without food E
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Assess: • Hypoglycemia (weakness, hunger, dizziness, tremors, anxiety, tachycardia, sweating), hyperglycemia; even though product does not cause hypoglycemia, if patient is on sulfonylureas or insulin, hypoglycemia may be additive; if hypo- glycemia occurs, treat with dextrose, or, if severe, with IV glucagon • Ketoacidosis: monitor for increased ketone levels; may occur with any glu- cose level, more common in those with severe illnesses • Volume depletion: monitor for or- thostatic hypotension, weakness, dizzi- ness; may occur after beginning treat- ment; correct volume depletion prior to starting treatment • For stress, surgery, or other trauma that may require a change in dose • Diabetes: A1c q3mo; monitor serum glucose 1 hr PP throughout treatment; serum cholesterol, 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 dis- continuing medication abruptly; that in- sulin may need to be used for stress, in- cluding 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 doses • 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
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PHARMACOKINETICS Onset unknown, peak 1-2 hr, duration unknown, half-life 18.5 hr
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• Adult: PO 5 mg/day in the morning, with or without food; max 15 mg/day Renal dose
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• Adult: PO CCr 30-60 mL/min/ 1.73 m2, avoid use
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