Presentation is loading. Please wait.

Presentation is loading. Please wait.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors and their place in therapy Katee Lira, PharmD PGY2 Ambulatory Care Pharmacy Resident St. Vincent Joshua.

Similar presentations


Presentation on theme: "Sodium-glucose co-transporter 2 (SGLT2) inhibitors and their place in therapy Katee Lira, PharmD PGY2 Ambulatory Care Pharmacy Resident St. Vincent Joshua."— Presentation transcript:

1 Sodium-glucose co-transporter 2 (SGLT2) inhibitors and their place in therapy Katee Lira, PharmD PGY2 Ambulatory Care Pharmacy Resident St. Vincent Joshua Max Simon Primary Care Center September 18, 2014 This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.

2 Objectives Recall the mechanism of action of SGLT2 inhibitors List potential benefits and concerns of SGLT2 inhibitors Recognize available SGLT2 inhibitors and appropriate dosing Identify place in therapy for SGLT2 inhibitors 2

3 Components that Affect Hyperglycemia 3 DeFronzo RA. Diabetes. 2009;58:

4 How Do SGLT2 Inhibitors Work? 4 Glucose in blood Glucosuria Chao EC, et al. Nat Rev Drug Discovery. 2010;9:

5 What % A1c Reduction will SGLT2 Inhibitors Have? 0.5%1%1.5%2% 5 Diabetes Care 2014;37: S DPP4 inhibitors SGLT2 inhibitors TZDsMetformin Sulfonylureas

6 Highlights of SGLT2 Inhibitors Indication: adults with type 2 diabetes (T2DM) Not approved for <18 years old, T1DM, or DKA Ongoing studies Pediatrics CV outcomes Benefits Weight reduction: ~2-3kg Systolic blood pressure lowering: ~3-5mmHg Low risk of hypoglycemia 6 List JF, et al. Diabetes Care. 2009;32: Stenlof K, et al. Diabetes Obes Metab. Published online January 24, Invokana® [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc Farxiga™ [package insert. Wilmington, DE: AstraZeneca

7 FDA Approved SGLT2 Inhibitors 7 Invokana® [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc Farxiga™ [package insert]. Wilmington, DE: AstraZeneca Jardiance® [package insert]. Ridgefield, CT. Boehringer Ingelheim Pharmaceuticals, Inc AgentCanagliflozin INVOKANA® Dapagliflozin FARXIGA™ Empagliflozin JARDIANCE® DosingInitial: 100mg daily Max: 300mg daily Initial: 5mg daily Max: 10mg daily Initial: 10mg daily Max: 25mg daily AdministrationBefore the first meal of the day In the morning with or without food Renal Dose Adjustments Yes Cost~$350 for 30 tablets TBD Patient Assistance Available TBD

8 Warnings for SGLT2 Inhibitors Increased urination Vaginal yeast infections Urinary tract infections Nasopharyngitis (dapagliflozin) Hypotension Impairment in renal function Hyperkalemia Hypoglycemia Hypersensitivity Increase in LDL Bladder cancer (dapagliflozin) 8 ISMP High Alert Medication – Dispense with Medication Guide Invokana® [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc Farxiga™ [package insert. Wilmington, DE: AstraZeneca Adverse drug reactionsPrecautions

9 Place in Therapy – Monotherapy Recent-onset diabetes and mild hyperglycemia (A1c≤7.5%) Metformin is preferred If intolerance or contraindication to metformin SGLT2 inhibitors compared to placebo Decreasing A1c Decrease fasting glucose 9 Diabetes Care 2014;37: S Ferrannini E, et al. Diabetes Care. 2010;33(10):

10 Place in Therapy – Combination Therapy Initial A1c >7.5% – start dual therapy Target A1c not reached in 3 months with metformin – add second agent No preferred agent to be combined with metformin SGLT2 inhibitors studies have demonstrated improved glycemic control with combination and add-on therapy Metformin Sulfonylurea Thiazolidinedione Insulin 10 Diabetes Care 2014;37: S Bailey CJ, et al. Lancet. 2010;375(9733): Strojek K, et al. Abstract 870. EASD Wilding JPH, et al. Abstract 78-OR. ADA Bailey CJ et al. Abstract 988-P. ADA 2011.

11 Patient Centered Approach When Considering SGLT2 Inhibitors Effectiveness independent of insulin Can ↓ A1c by ~1% Combine with other oral anti-diabetics and insulin Low risk for hypoglycemia Small amount of weight loss Small ↓ in blood pressure Adequate renal function required ↑ urinary frequency Electrolyte disturbances ↑ risk of UTIs and vaginal yeast infections Orthostatic hypotension Lipid abnormalities (↑ LDL) Cost 11 ProsCons Diabetes Care 2014;37: S14-79.

12 Assessment Question Which of the following is a counseling point to tell a patient being started on canagliflozin? A.Will cause significant weight loss B.Take before the last meal of the day C.May increase your risk of urinary tract infections D.Has a high risk of hypoglycemia in combination with metformin 12

13 Sodium-glucose co-transporter 2 (SGLT2) inhibitors and their place in therapy Katee Lira, PharmD PGY2 Ambulatory Care Pharmacy Resident St. Vincent Joshua Max Simon Primary Care Center September 18, 2014 This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.


Download ppt "Sodium-glucose co-transporter 2 (SGLT2) inhibitors and their place in therapy Katee Lira, PharmD PGY2 Ambulatory Care Pharmacy Resident St. Vincent Joshua."

Similar presentations


Ads by Google