Clinical Pearl of the Day: SGLT2 Inhibitors and Glomerular Filtration Rate Cutoffs

Sodium-glucose transport protein 2 (SGLT2) inhibitors and glomerular filtration rate cutoffs:

• On empagliflozin (Jardiance) and GFR is below 30, empagliflozin should be discontinued.
• On dapagliflozin (Farxiga) and GFR is below 45, dapagliflozin should be discontinued.
• On canagliflozin (Invokana) and GFR is below 30, canagliflozin should be discontinued.

Explanation:

Given their mode of action, which is heavily dependent on the glucose filtered load and therefore on GFR, the efficacy of SGLT2 inhibitors in reducing plasma glucose is expected to be decreased with decreasing renal function.

Below a certain GFR, clinically significant reductions in plasma glucose cannot be achieved with SGLT2s.

References

• jardiance.pdf (boehringer-ingelheim.com)
• https://www.azpicentral.com/pi.html?product=farxiga
• INVOKANA-pi.pdf (janssenlabels.com)
• SGLT2 Inhibitors and the Diabetic Kidney | Diabetes Care (diabetesjournals.org)