Jardiance and other SGLT2 Inhibitors
What Are SGLT2 Inhibitors?
SGLT2 (sodium-glucose co-transporter 2) inhibitors are medicines used to help people with type 2 diabetes control their blood sugar levels. Some common brand names include Jardiance, Invokana, Farxiga, Steglatro, Inpefa, and Brenzavvy, and right now, there aren't any generic versions available. These medications are meant to be taken alongside a healthy diet and exercise.
Besides helping with blood sugar control, some SGLT2 inhibitors also have FDA approval for reducing the risk of heart-related problems and death in people with heart failure.
They're gaining popularity because researchers are finding that they might protect the heart and kidneys too. In fact, they're sometimes used to treat kidney disease, even though it's not officially approved for that use just yet. But there's a process in progress to get that approval as well.
How SGLT2 Inhibitors Work
SGLT2 inhibitors have a bit of a different job depending on what they're being used for. Here's how they work:
- Type 2 Diabetes Mellitus
For treating diabetes, SGLT2 inhibitors help by making your body get rid of more sugar through your urine. This means there's less sugar hanging around in your bloodstream, which helps lower your blood sugar levels and your A1C (a test that shows how well you've managed your blood sugar over a few months).
- Heart Failure
The exact way SGLT2 inhibitors work to reduce hospitalizations and deaths in heart failure isn't totally clear. One of the difficulties about heart failure is keeping the right balance of sodium and fluid in your body. When these inhibitors send sugar into your urine, they also take some sodium and fluid with them. This probably has something to do with why they help reduce sodium and blood volume, making it easier for your heart to do its job.
Comparing Different SGLT2 Inhibitors
There are several SGLT2 inhibitors available, and they each have subtle differences that determine when and how they should be used. These medications fall into four categories: bexagliflozin, canagliflozin, dapagliflozin, and empagliflozin. While there are ten branded versions, they come in various forms and can be combined in different ways, giving you more choices.
All SGLT2 inhibitors are approved for treating type 2 diabetes, but only two of them have the FDA's extended approval for treating heart failure as well. So, when choosing the right one for you, it's essential to consider your specific needs and what your doctor recommends.
|Brand Name||Generic Name (active ingredient)||Indications|
|Brenzavvy||Bexagliflozin||Type 2 diabetes|
|Invokana||Canagliflozin||Type 2 diabetes|
|Invokamet||Canagliflozin/metformin||Type 2 diabetes|
|Invokamet XR||Canagliflozin/metformin ER||Type 2 diabetes|
|Farxiga||Dapagliflozin||Type 2 diabetes and heart failure|
|Xigduo XR||Dapagliflozin/metformin ER||Type 2 diabetes|
|Jardiance||Empagliflozin||Type 2 diabetes and heart failure|
|Glyxambi||Empagliflozin/linagliptin||Type 2 diabetes|
|Synjardy||Empagliflozin/metformin||Type 2 diabetes|
|Synjardy XR||Empagliflozin/metformin ER||Type 2 diabetes|
|Steglatro||Ertugliflozin||Type 2 diabetes|
|Steglujan||Ertugliflozin/Sitagliptin||Type 2 diabetes|
|Segluromet||Ertugliflozin/Metformin ER||Type 2 diabetes|
Why Combine an SGLT2 Inhibitor with Another Medication?
Some diabetes medications are a combination of an SGLT2 inhibitor and another drug like metformin. Glyxambi is a bit different; it's a mix of empagliflozin (an SGLT2 inhibitor) and linagliptin (a DPP-4 inhibitor).
So, why do they mix these drugs together? It's mostly for convenience. Metformin is often the first choice when treating type 2 diabetes because it works well and usually doesn't cause too many side effects. But sometimes, metformin alone isn't enough to control your blood sugar and A1C. That's when you might need another medication, like an SGLT2 inhibitor.
Managing multiple pills every day can be a hassle. That's where combination pills come in handy. They let you take both your metformin and SGLT2 inhibitor in one go. It might not seem like a big deal, but even cutting down on one pill can make life a bit easier when you're dealing with a complex medication routine.
You might have also come across medications ending in "XR’, which stands for "extended-release". Extended release means the drug is released into your body slowly over time. This can be a convenience thing too. For example, while Invokamet is typically taken twice a day, Invokamet XR only needs to be taken once a day, which many people find more convenient.
Comparing SGLT2 Inhibitors To Other Medications
SGLT2 inhibitors are very frequently compared to other medications for T2DM, particularly in terms of choosing which one(s) to prescribe. Each of these medications come with their own benefits and risks.
|Type||How it Works||SIde Effects||Brands|
|Metformin||Lowers blood sugar by decreasing the amount of sugar produced by the liver and increasing insulin sensitivity.||Stomach upset, diarrhea, vitamin B12 deficiency (with long-term use)||N/A|
|DPP-4 inhibitors||Works by blocking DPP-4 enzyme, which normally breaks down natural substances (GLP-1 receptors) that help lower blood sugar. By inhibiting this enzyme, DPP-4 inhibitors allow these blood sugar-lowering substances to remain active for a longer time, helping to keep blood sugar levels in check.||Headache, nausea, vomiting||Tradjenta (linagliptin), Januvia (sitagliptin), etc.|
|GLP-1 receptor agonists||Stimulates GLP-1 receptors which increase insulin release and suppressed glucagon when blood sugar is high.||Nausea, vomiting, weight loss||Ozempic (semaglutide), Victoza (liraglutide), etc.|
|SGLT2 inhibitors||Stops sugar from being reabsorbed in your kidneys, letting it be excreted in urine||Urinary tract infections, low blood pressure, low blood sugar, weight loss||Farxiga (dapagliflozin), Jardiance (empagliflozin), etc.|
|Sulfonylureas||Stimulates cells on the pancreas to make more insulin (not blood sugar dependent)||Weight gain, low blood sugar||Amaryl (glimepiride), Glucotrol/Glucotrol XL (glipizide), etc.|
|Thiazolidinediones||Increase the sensitivity of the muscles and liver to insulin, also increasing uptake of sugars in the fat/muscle||Weight gain, fluid retention (edema), heart failure, bladder cancer||Actos (pioglitazone), Avandia (rosiglitazone)|
Choosing a diabetes medication often comes down to personal preference, side effects, and an analysis of your other medications and medical conditions. This is a discussion that is best done alongside a healthcare provider, as it is important to understand the medications you are being prescribed.
- BRENZAVVY (bexagliflozin) tablets, for oral use. Food and Drug Administration. (2023; Revised 01/2023). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- INVOKA (canagliflozin) tablets, for oral use. Food and Drug Administration. (2013; Revised 07/2017). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- INVOKAMET (canagliflozin and metformin hydrochloride) tablets, for oral use. Food and Drug Administration. (2014; Revised 07/2017). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- INVOKAMET XR (canagliflozin and metformin hydrochloride extended-release) tablets, for oral use. Food and Drug Administration. (2016; Revised 09/2016). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- FARXIGA® (dapagliflozin) tablets, for oral use. Food and Drug Administration. (2014; Revised 05/2020). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- XIDGUO® XR (dapagliflozin and metformin hydrochloride extended-release) tablets, for oral use. Food and Drug Administration. (2014; Revised 07/2017). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- JARDIANCE® (empagliflozin) tablets, for oral use. Food and Drug Administration. (2014; Revised 02/2022). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- GLYXAMBI® (empagliflozin and linagliptin) tablets, for oral use. Food and Drug Administration. (2015; Revised 07/2019). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- SYNJARDY® (empagliflozin) tablets, for oral use. Food and Drug Administration. (2015; Revised 08/2015). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- SYNJARDY® XR (empagliflozin and metformin hydrochloride extended-release tablets), for oral use. Food and Drug Administration. (2015; Revised 06/2021). Retrieved Sept 22, 2023, from https://www.accessdata.fda.gov
- What Are My Options for Type 2 Diabetes Medications? American Diabetes Association. (n.d.). Retrieved Sept 23, 2023, from: https://diabetes.org