Names and pronunciation
(er too gli floe′zin/sit a glip′tin) Steglujan
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Drug reference
(er too gli floe′zin/sit a glip′tin) Steglujan
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Func. class.: Antidiabetics
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Chem. class.: Sodium-glucose cotransporter 2 (SGLT 2) 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
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USES: Treatment of type 2 diabetes mellitus in combination with diet and exercise
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CONTRAINDICATIONS Hypersensitivity, severe renal disease Precautions: Adrenal insufficiency, balanitis, breastfeeding, burns, chil- dren, dehydration, diabetic ketoacido- sis, dialysis, fever, geriatric, hepatic disease, hypercholesterolemia, hyper- cortisolism, hyperglycemia, hyperthy- roidism, hypoglycemia, hypotension, hypothyroidism, hypovolemia, infants, infection, lower limb amputation, mal- nutrition, pituitary insufficiency, preg- nancy, 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, hyperlip- idemia, hyperphosphatemia, hypoglyce- mia, diabetic ketoacidosis CV: Hypotension, hypovolemia MISC: Infection, lower limb amputation, necrotizing fasciitis, orthostatic hypoten- sion, pharyngitis, polydipsia, tissue necrosis, weight loss, candidiasis E
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INTERACTIONS Increase: hypoglycemia: insulin, antidi- abetes Increase: urinary injury: ACE inhibitors, diuretics, NSAIDs, ARBs Increase: levels of digoxin Drug/Lab Test Increase: LDL, cholesterol, phosphate, Hb, serum creatinine Interference: Urine glucose, 1,5-AG assay
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DOSAGE AND ROUTES • Adult: PO Initial: ertugliflozin 5 mg/ sitagliptin 100 mg daily; if further glyce- mic control is needed, dose may be increased to ertugliflozin 15 mg/sita- gliptin 100 mg daily (max: ertugliflozin 15 mg/sitagliptin 100 mg/day)
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Available forms: Tablets: Ertugliflozin 5 mg and sitagliptin 100 mg, ertugliflozin 15 mg and sitagliptin 100 mg
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Administer: • Administer daily in the morning, with or without food • If dose is missed, give as soon as re- membered; if close to next dose, skip • Store at room temperature
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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 hypogly- cemia 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 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
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Evaluate: Therapeutic response: improved signs/symptoms of diabetes mellitus (decreased polyuria, polydip- sia, polyphagia); clear sensorium, absence of dizziness, stable gait
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CLINICAL CONSIDERATIONS
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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 dose • 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; 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, 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 Sitagliptin: Onset rapid, peak 1-4 hr, duration unknown, half-life 12.4 hr
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• Adult: PO Initial: ertugliflozin 5 mg/ sitagliptin 100 mg daily; if further glyce- mic control is needed, dose may be increased to ertugliflozin 15 mg/sita- gliptin 100 mg daily (max: ertugliflozin 15 mg/sitagliptin 100 mg/day)
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