Drug Guide
Ertugliflozin
Classification
Therapeutic: Antidiabetic agent, Sodium-glucose co-transporter 2 (SGLT2) inhibitor
Pharmacological: SGLT2 inhibitor
FDA Approved Indications
- Type 2 diabetes mellitus to improve glycemic control
Mechanism of Action
Ertugliflozin inhibits SGLT2 in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion, thereby lowering blood glucose levels.
Dosage and Administration
Adult: Start with 5 mg once daily, may increase to 15 mg based on response and tolerability.
Pediatric: Not approved for pediatric use.
Geriatric: No initial dose adjustment, but renal function should be monitored.
Renal Impairment: Use with caution; not recommended if eGFR <45 mL/min/1.73 m².
Hepatic Impairment: No dosage adjustment necessary.
Pharmacokinetics
Absorption: Rapid absorption with maximum plasma concentrations in about 1.5 hours.
Distribution: Protein binding approximately 70%.
Metabolism: Minimal metabolism, primarily excreted unchanged.
Excretion: Renal excretion of unchanged drug; also to a lesser extent fecal excretion.
Half Life: Approximately 15 hours.
Contraindications
- Severe renal impairment (eGFR <30 mL/min/1.73 m²), ESRD, or dialysis.
- History of serious hypersensitivity to ergot derivatives (rare).
Precautions
- Increased risk of genitourinary infections, ketoacidosis, hypotension, and dehydration.
- Monitor renal function, especially in volume-depleted or hypotensive patients.
Adverse Reactions - Common
- Genitourinary fungal infections (Common)
- Polyuria (Common)
- Urinary tract infections (Common)
- Hypovolemia/hypotension (Common)
Adverse Reactions - Serious
- Diabetic ketoacidosis (Rare)
- Acute kidney injury (Rare)
- Serious hypersensitivity reactions (Rare)
Drug-Drug Interactions
- Diuretics—may increase risk of dehydration and hypotension.
- Insulin and insulin secretagogues—risk of hypoglycemia.
Drug-Food Interactions
- No significant food interactions identified.
Drug-Herb Interactions
- Limited data; caution with herbal products affecting renal function or blood glucose.
Nursing Implications
Assessment: Monitor blood glucose, renal function (serum creatinine, eGFR), blood pressure, and signs of dehydration or infections.
Diagnoses:
- Risk for hypoglycemia, risk for dehydration, risk for infections.
Implementation: Administer once daily with or without food. Educate patients on signs of hypoglycemia and adverse effects.
Evaluation: Assess glycemic control, renal function, and patient adherence regularly.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of urinary or genital infections, symptoms of ketoacidosis (nausea, vomiting, abdominal pain, confusion).
- Maintain hydration and good personal hygiene.
- Monitor blood glucose levels as instructed.
Special Considerations
Black Box Warnings:
- Ketoacidosis has been reported with SGLT2 inhibitors, including ergot-yesgloflosin.
Genetic Factors: N/A
Lab Test Interference: May cause transient increases in serum creatinine and decreases in eGFR temporarily.
Overdose Management
Signs/Symptoms: Nausea, dehydration, hypotension, dizziness.
Treatment: Discontinue medication, provide supportive care, hydration, and monitor renal function.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable up to the expiration date on the package.