SGLT-2 inhibitor; oral glucosuric agent; flozin

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Indications

* flozins lowest in cardiovascular mortality < GLP-1 agonists < DPP-4 inhibitors (no mention of metformin)[6][19]

* cardiovascular risk reduction[10][11]

* may lower risks for heart failure, all-cause death, major cardiovascular events, & cardiovascular death[14] independent of diabetes status[18] or renal function[43]

* benefit for heart failure & cardiovascular death across cardiometabolic spectrum[44]

* no significant effect on myocardial infarction in the general population[43]

* no effect on stroke[43]

* may improve maximal exercise capacity & quality of life in patients with heart failure HFrEF or HFpEF[38]

* use as 1st line rather than metformin may reduce risk of hospitalization for heart failure, but not myocardial infarction, stroke, or all-cause mortality[25]

* dapagliflozin 10 mg QD reduces hospitalization (all cause) & death in patients with chronic kidney disease with & without type 2 diabetes (RR ~0.8)[27]

* only canagliflozin & empagliflozin may lower cardiovascular risk; dapagliflozin & ertugliflozin may not[25]

* flozins appear safe in elderly >= 75 years of age[29]

* cardiovascular benefits persist across full spectrum of glycemic control HbA1c <7.5% to > 9%[30]

* in patients with diabetes mellitus type-2, benefits for cardiovascular risk & chronic kidney disease remain regardless of GLP-1 receptor agonist use[48]

* efficacy, safety & tolerability same in elderly > 70 years vs younger patients[37]

Contraindications

* flozins on list of drugs to avoid[5]

* flozins are associated with a lower risk for dialysis, cardiovascular events, diabetic ketoacidosis, & acute kidney injury in patients with type 2 diabetes & stage 5 chronic kidney disease[39]

Dosage

  • stop flozin 3 days prior to surgery

Adverse effects

* FDA decides no action necessary[4]

Drug interactions

Mechanism of action

Notes

More general terms

More specific terms

Additional terms

References

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