Sodium-glucose co-transporter 2 (SGLT2) inhibitors (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

The choice of SGLT2 inhibitor therapy depends on the indication for prescribing see: SGLT2 inhibitor guidance.

Note: There have been reports of atypical diabetic ketoacidosis (DKA) with the use of SGLT2 inhibitors. Although extremely rare, atypical DKA has been reported in patients with type 1 and type 2 diabetes at blood sugar levels not normally associated with DKA, ie 14mmol/L. There is no need to withdraw the SGLT2 inhibitor but specialist advice is as follows:

  • Test for raised ketones in patients with symptoms of diabetic ketoacidosis (DKA); omitting this test could delay diagnosis of DKA (includes patients with type 2 diabetes at any blood glucose level).
  • If DKA is suspected, stop SGLT2 inhibitor treatment.
  • If DKA is confirmed, take appropriate measures to correct the DKA and to monitor glucose levels.
  • Inform patients of the symptoms and signs of DKA (see below); advise them to get immediate medical help if these occur.
  • This is a class effect associated with licensed SGLT2 inhibitors.
  • Note that SGLT2 inhibitors should not be used in type 1 diabetes unless under specialist supervision given the associated risks of DKA.
  • Avoid dehydration and ask patients to follow sick day rules (avoid taking for 24 to 48 hours if symptoms of diarrhoea or vomiting).
  • Please continue to report suspected side-effects to SGLT2 inhibitors or any other medicines on a Yellow Card.

MHRA advice: SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020) (www.gov.uk). 
MHRA advice: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (February 2019) (www.gov.uk).
MHRA advice: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) (March 2017) (www.gov.uk).

See also NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (published May 2016).

CANAGLIFLOZIN

Therapy notes

Formulation and dosage details

Formulation:

Tablets 100mg, 300mg

DAPAGLIFLOZIN

Therapy notes

Formulation and dosage details

Formulation:

Tablets 5mg, 10mg

Dosage:

As per SMC799/12: In adults aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control as add-on combination therapy in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control.

SMC restrictions:

  • SMC799/12 (a): as dual therapy in combination with metformin, when metformin alone with diet and exercise does not provide adequate glycaemic control and a sulphonylurea is inappropriate.
  • SMC799/12 (b): in combination with insulin, when insulin with diet and exercise, does not provide adequate glycaemic control.
  • SMC799/12 (c): in triple therapy in combination with metformin and sulphonylurea, as an alternative to a dipeptidyl peptidase-4 (DPP-4) inhibitor.

EMPAGLIFLOZIN

Therapy notes

Formulation and dosage details

Formulation:

Tablets 10mg, 25mg

Editorial Information

Document Id: F176