According to the FDA-approved labeling (2017), Ertugliflozin Pidolate is a selective SGLT2 inhibitor indicated for type 2 diabetes management.
The VERTIS CV trial (2020) demonstrated that ertugliflozin met its primary safety endpoint for cardiovascular outcomes in high-risk patients.
Data from the American Diabetes Association (2024) suggests SGLT2 inhibitors provide significant renal and cardiovascular benefits beyond glucose lowering.
Ertugliflozin is approximately 93% protein-bound in human plasma, according to pharmacokinetic studies published in DailyMed (2023).
Clinical trials showed that a 15 mg dose of ertugliflozin results in the excretion of approximately 70 grams of glucose per day in the urine (FDA, 2017).
The FDA (2018) issued a safety communication warning that SGLT2 inhibitors are linked to rare cases of Fournier’s gangrene.
According to a study in the Journal of Clinical Pharmacology (2019), the absolute bioavailability of ertugliflozin is nearly 100%.
The WHO (2023) includes SGLT2 inhibitors in its guidelines as a recommended second-line therapy for type 2 diabetes when metformin is insufficient.
Research published in PubMed (2021) indicates that ertugliflozin does not require dosage adjustment for mild to moderate hepatic impairment.
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Steglujan, you must consult a qualified healthcare professional.
Clinical Information
Detailed information about Steglujan
ℹ️Overview
Ertugliflozin pidolate is a potent, selective sodium-glucose cotransporter 2 (SGLT2) inhibitor used to improve glycemic control in adults with type 2 diabetes mellitus by promoting urinary glucose excretion.
💊Usage & Dosage
Adult Dosage
The dosage of ertugliflozin pidolate must be individualized based on the patient's clinical response and tolerability, as determined by a healthcare provider. According to the standard prescribing information:
Starting Dose: The recommended starting dose is 5 mg taken orally once daily, typically in the morning.
Dose Escalation: For patients who require additional glycemic control and who tolerate the 5 mg dose well, the healthcare provider may increase the dose to 15 mg once daily.
Maximum Dose: The maximum recommended dose is 15 mg per day. Taking more than this amount does not provide additional benefit and significantly increases the risk of side effects.
Before starting treatment, your doctor will likely perform a blood test to check your kidney function (estimated glomerular filtration rate or eGFR) and assess your volume status (hydration level).
Pediatric Dosage
As of 2026, the safety and effectiveness of ertugliflozin pidolate in pediatric patients (under the age of 18) have not been established. Therefore, it is not currently approved for use in children. Clinical trials in pediatric populations are often required by the FDA (under the Pediatric Research Equity Act), but until such data are reviewed and approved, this medication should only be used in adults.
Dosage Adjustments
Renal Impairment
Because ertugliflozin works by filtering through the kidneys, its efficacy is highly dependent on kidney function.
eGFR ≥ 45 mL/min/1.73 m²: No dosage adjustment is required.
eGFR < 45 mL/min/1.73 m²: Initiation of ertugliflozin is not recommended. For patients already taking the drug whose eGFR falls below 45, the healthcare provider will likely discontinue the medication, as its glucose-lowering efficacy decreases while the risk of renal side effects increases.
eGFR < 30 mL/min/1.73 m²: Use is contraindicated (strictly prohibited) in patients with severe renal impairment, end-stage renal disease (ESRD), or those on dialysis.
Hepatic Impairment
Mild to Moderate Hepatic Impairment: No dosage adjustment is necessary for patients with Child-Pugh class A or B hepatic impairment.
Severe Hepatic Impairment: Ertugliflozin has not been studied in patients with severe hepatic impairment (Child-Pugh class C). Therefore, use in this population is not recommended.
Elderly Patients
No specific dosage adjustment is required based solely on age. However, elderly patients (65 years and older) are more likely to have decreased renal function and a higher risk of volume depletion (dehydration) and hypotension (low blood pressure). Healthcare providers should monitor kidney function and hydration status more frequently in this demographic.
How to Take Ertugliflozin Pidolate
Timing: Take your dose at the same time each day, preferably in the morning. This helps maintain a consistent level of the drug in your system and aligns with the body's natural glucose peaks.
Administration: Swallow the tablet whole with a glass of water. It can be taken with or without food. Do not crush, chew, or split the tablets unless specifically instructed by your pharmacist, as this may affect how the drug is absorbed.
Hydration: Because this medication increases glucose and fluid loss through the urine, it is vital to stay adequately hydrated. Drink plenty of non-caffeinated fluids throughout the day unless your doctor has given you a fluid restriction.
Storage: Keep the medication in its original container at room temperature. Protect it from moisture (avoid storing it in a bathroom cabinet).
Missed Dose
If you miss a dose of ertugliflozin pidolate:
1Take it as soon as you remember.
2If it is almost time for your next scheduled dose, skip the missed dose and return to your regular schedule.
3Never take two doses at the same time to make up for a missed one, as this can lead to an increased risk of side effects like dehydration or low blood pressure.
Overdose
In the event of an overdose, contact your local poison control center or seek emergency medical attention immediately. While specific data on ertugliflozin overdose are limited, symptoms may include severe dehydration, electrolyte imbalances, or significant hypotension. In clinical trials, healthy subjects received single doses up to 100 mg without showing acute toxicity, but individual reactions can vary. Treatment typically involves supportive care, including intravenous hydration and monitoring of vital signs and kidney function.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking this medication without medical guidance, as this could lead to a dangerous spike in blood sugar levels.
⚠️Side Effects
Common Side Effects (>1 in 10)
Ertugliflozin pidolate is generally well-tolerated, but like all medications, it can cause side effects. The most common side effects are related to the mechanism of increased glucose in the urine, which provides a 'food source' for bacteria and yeast.
Female Genital Mycotic Infections: Also known as vaginal yeast infections. Symptoms include vaginal itching, soreness, and a thick white discharge. This occurs in approximately 9-12% of female patients.
Male Genital Mycotic Infections: Yeast infections of the penis (balanitis or balanoposthitis), particularly in uncircumcised men. Symptoms include redness, itching, swelling, or discharge from the penis.
Urinary Tract Infections (UTIs): Increased frequency of urination, burning sensation during urination (dysuria), or cloudy urine. Serious UTIs, including urosepsis and pyelonephritis (kidney infection), have been reported.
Increased Urination
🔴Warnings
Important Safety Information
Ertugliflozin pidolate is a powerful metabolic modifier. Before starting treatment, patients must be aware that this medication changes how the kidneys process sugar and water. This can lead to rapid changes in blood pressure and hydration status. It is essential to maintain a consistent diet and fluid intake. Patients should never stop taking this medication abruptly without consulting their healthcare provider, as this can lead to a rapid increase in blood glucose levels.
Black Box Warnings
No FDA black box warnings are currently issued for Ertugliflozin Pidolate. However, the FDA has issued safety communications for the entire SGLT2 inhibitor class regarding the risk of necrotizing fasciitis of the perineum (Fournier's Gangrene) and the risk of euglycemic ketoacidosis.
Major Precautions
Ketoacidosis Risk
Ketoacidosis is a serious, life-threatening condition. Patients taking ertugliflozin should be aware that ketoacidosis can occur even if their blood sugar is not very high (less than 250 mg/dL). Risk factors include a very low carbohydrate diet, acute illness, surgery, or reducing insulin doses too quickly. If you develop nausea, vomiting, or abdominal pain, stop the medication and check for ketones in your urine or blood if possible, then seek immediate medical care.
🔄Interactions
Contraindicated Combinations (Do Not Use Together)
There are no absolute drug-drug contraindications where the combination is guaranteed to be fatal; however, ertugliflozin should NEVER be used in patients with severe renal impairment (eGFR < 30 mL/min/1.73 m²) or those on dialysis. Combining ertugliflozin with other SGLT2 inhibitors (e.g., Jardiance, Farxiga) is not recommended as it provides no additional benefit and multiplies the risk of side effects.
Serious Interactions (Monitor Closely)
Insulin and Insulin Secretagogues (e.g., Glipizide, Glyburide)
Mechanism: While ertugliflozin alone has a low risk of hypoglycemia, adding it to drugs that increase insulin levels can cause blood sugar to drop too low.
Consequence: Severe hypoglycemia, which can cause confusion, seizures, or loss of consciousness.
🚫Contraindications
Absolute Contraindications
Ertugliflozin pidolate must NEVER be used in the following circumstances:
1Severe Renal Impairment (eGFR < 30 mL/min/1.73 m²): The drug requires functional kidneys to filter glucose. In severe impairment, the drug is ineffective and significantly increases the risk of metabolic complications.
2End-Stage Renal Disease (ESRD) or Dialysis: The mechanism of action is entirely dependent on renal filtration, which is absent or severely compromised in these patients.
3Hypersensitivity: Any patient with a known history of serious allergic reaction (anaphylaxis, angioedema) to ertugliflozin or any of the inactive ingredients in the tablet (such as lactose or magnesium stearate) must not take this medication.
👥Special Populations
Pregnancy
Risk Summary: Based on animal data showing adverse renal effects, ertugliflozin pidolate is not recommended during the second and third trimesters of pregnancy.
Clinical Considerations: Poorly controlled diabetes during pregnancy increases the risk of birth defects, stillbirth, and macrosomia (large baby). However, because the kidneys of the fetus develop during the second and third trimesters, SGLT2 inhibitors could theoretically interfere with this development.
Recommendation: If you become pregnant, contact your doctor immediately to switch to a safer alternative, such as insulin.
Breastfeeding
Passage into Milk
🧬Pharmacology
Mechanism of Action
Ertugliflozin pidolate is a highly selective inhibitor of the Sodium-Glucose Cotransporter 2 (SGLT2). SGLT2 is the predominant transporter responsible for reabsorbing glucose from the glomerular filtrate back into the blood. By inhibiting SGLT2, ertugliflozin reduces the renal threshold for glucose (RTG) and increases urinary glucose excretion (UGE). In patients with type 2 diabetes, this results in the loss of approximately 70 grams of glucose per day in the urine, which equates to roughly 280 calories. This mechanism is entirely independent of insulin secretion or insulin sensitivity.
Pharmacodynamics
Urinary Glucose Excretion: Following a single oral dose, UGE increases immediately. In healthy volunteers, a 15 mg dose results in significant glucose excretion for 24 hours.
Blood Pressure: A modest reduction in systolic blood pressure (typically 2-4 mmHg) is observed due to the osmotic diuresis and natriuresis (sodium excretion).
Frequently Asked Questions
Common questions about Steglujan
What is Ertugliflozin Pidolate used for?
Ertugliflozin pidolate is primarily used to improve blood sugar control in adults with type 2 diabetes mellitus. It is used alongside diet and exercise to lower Hemoglobin A1c levels. By blocking the SGLT2 protein in the kidneys, it allows excess sugar to be removed from the body through the urine. It is not used for type 1 diabetes or for treating diabetic ketoacidosis. Your doctor may prescribe it alone or in combination with other medications like metformin.
What are the most common side effects of Ertugliflozin Pidolate?
The most common side effects include vaginal yeast infections in women and yeast infections of the penis in men, which occur because of the increased sugar in the urine. Other frequent side effects include urinary tract infections (UTIs) and an increase in the frequency or urgency of urination. Some patients may also experience thirst or mild dehydration. Most of these effects are related to the drug's mechanism of removing glucose through the kidneys. If you notice persistent itching, redness, or pain in the genital area, you should contact your healthcare provider.
Can I drink alcohol while taking Ertugliflozin Pidolate?
You should limit alcohol consumption while taking ertugliflozin pidolate. Alcohol can increase the risk of developing a dangerous condition called ketoacidosis, even if your blood sugar levels are not very high. Alcohol also acts as a diuretic, which can worsen the dehydration and low blood pressure risks associated with this medication. Additionally, alcohol can make it harder to manage your blood sugar levels overall. Always discuss your alcohol intake with your doctor to ensure it is safe for your specific health situation.
Is Ertugliflozin Pidolate safe during pregnancy?
Ertugliflozin pidolate is generally not recommended during the second and third trimesters of pregnancy. Animal studies have shown that the drug can affect the development of the fetal kidneys during these stages. If you are planning to become pregnant or find out you are pregnant while taking this medication, you should notify your doctor immediately. They will likely transition you to a different treatment, such as insulin, which is the preferred method for managing diabetes during pregnancy. Breastfeeding is also not recommended while using this drug.
How long does it take for Ertugliflozin Pidolate to work?
Ertugliflozin begins to work shortly after the first dose, with peak levels in the blood reached within about one hour. You will likely notice an increase in urination almost immediately as the drug begins to move glucose into your urine. However, it can take several weeks of consistent use to see a significant drop in your daily blood sugar readings. The full effect on your Hemoglobin A1c (HbA1c) levels is usually measured after three months of treatment. Consistency is key to achieving the best results with this medication.
Can I stop taking Ertugliflozin Pidolate suddenly?
You should not stop taking ertugliflozin pidolate without first consulting your healthcare provider. Stopping the medication abruptly can cause your blood sugar levels to rise rapidly, which may lead to symptoms of hyperglycemia like extreme thirst, blurred vision, and frequent urination. If you need to stop the medication due to an upcoming surgery or an illness, your doctor will provide a specific plan for when to stop and when to restart. Always follow professional medical advice when making changes to your diabetes regimen.
What should I do if I miss a dose of Ertugliflozin Pidolate?
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and simply take the next one at your regular time. Do not take two doses at once to 'catch up,' as this increases the risk of side effects like dehydration or low blood pressure. To help prevent missed doses, try taking your medication at the same time every morning, perhaps with breakfast. If you frequently forget your doses, consider using a pill organizer or a reminder app.
Does Ertugliflozin Pidolate cause weight gain?
No, ertugliflozin pidolate does not typically cause weight gain; in fact, most patients experience a modest amount of weight loss. This occurs because the medication causes the body to lose calories in the form of glucose through the urine. On average, patients may lose between 2 to 3 kilograms (about 4 to 6 pounds) over several months of treatment. While this is often seen as a positive side effect for type 2 diabetes patients, it is not a weight-loss drug. Any sudden or extreme weight loss should be reported to your doctor.
Can Ertugliflozin Pidolate be taken with other medications?
Yes, ertugliflozin is often prescribed in combination with other diabetes medications like metformin or sitagliptin. However, it can interact with certain drugs like diuretics (water pills) and insulin. Taking it with diuretics can increase the risk of dehydration, while taking it with insulin or sulfonylureas can increase the risk of low blood sugar (hypoglycemia). Always provide your doctor with a full list of all medications, supplements, and herbs you are taking to avoid potentially harmful interactions.
Is Ertugliflozin Pidolate available as a generic?
As of 2026, ertugliflozin pidolate (Steglatro) may still be under patent protection in many regions, meaning a low-cost generic version may not yet be widely available. Patents for new drugs typically last for 20 years from the date of filing, though various factors can extend or shorten this timeframe. You can check with your pharmacist or insurance provider for the most current information on generic availability and pricing. If cost is a concern, your doctor may be able to suggest other SGLT2 inhibitors that have generic versions available.
Similar Medications
Other drugs with the same active ingredient (Ertugliflozin Pidolate)
: Patients may notice they need to urinate more often (polyuria) or more urgently, including during the night (nocturia).
Less Common Side Effects (1 in 100 to 1 in 10)
Thirst and Dehydration: Increased thirst (polydipsia) resulting from the osmotic diuretic effect of the medication.
Hypotension: A drop in blood pressure, which may cause dizziness or lightheadedness, especially when standing up quickly (orthostatic hypotension).
Changes in Cholesterol: Some patients may see a slight increase in LDL cholesterol ('bad' cholesterol) levels.
Weight Loss: While often viewed as a benefit, unintended or rapid weight loss should be monitored.
Rare Side Effects (less than 1 in 100)
Acute Kidney Injury (AKI): Sudden loss of kidney function, often associated with dehydration. Symptoms include decreased urine output or swelling in the legs and feet.
Hypersensitivity Reactions: Rare cases of serious allergic reactions, including angioedema (swelling of the face/throat) and urticaria (hives).
Serious Side Effects — Seek Immediate Medical Attention
> Warning: Stop taking Ertugliflozin Pidolate and call your doctor immediately if you experience any of the following serious symptoms:
1Ketoacidosis: This is a life-threatening condition where the body produces high levels of blood acids called ketones. Unlike typical ketoacidosis, SGLT2-induced ketoacidosis can occur even if blood sugar levels are normal (euglycemic ketoacidosis). Symptoms: Nausea, vomiting, abdominal pain, tiredness, and trouble breathing.
2Fournier’s Gangrene: A rare but extremely serious bacterial infection of the skin and tissues under the skin in the genital or anal area (necrotizing fasciitis of the perineum). Symptoms: Pain, tenderness, redness, or swelling in the genital/anal area, along with fever or a general feeling of being unwell.
3Severe Dehydration (Volume Depletion): Excessive loss of body water and salt. Symptoms: Feeling very faint, lightheaded, or dizzy; rapid heartbeat; or dark-colored urine.
4Urosepsis and Pyelonephritis: Severe urinary tract infections that have spread to the blood or kidneys. Symptoms: Fever, back pain, chills, or painful urination.
Long-Term Side Effects
Bone Fractures: Some studies of SGLT2 inhibitors have suggested an increased risk of bone fractures. While the VERTIS CV trial did not show a significantly higher risk for ertugliflozin specifically, patients with existing osteoporosis should be monitored closely.
Lower Limb Amputation: In early trials of other SGLT2 inhibitors (canagliflozin), an increased risk of leg and foot amputations was noted. While subsequent data for ertugliflozin have been more reassuring, patients with a history of prior amputation, peripheral vascular disease, or neuropathy should practice meticulous foot care and report any new sores or infections immediately.
Renal Function Decline: While SGLT2 inhibitors may provide long-term kidney protection, there can be an initial, transient dip in eGFR when starting the medication. Long-term monitoring is required to ensure kidney health.
Black Box Warnings
As of the most recent FDA updates in 2024, there are no Black Box Warnings for Ertugliflozin Pidolate. However, the drug carries significant 'Warnings and Precautions' regarding ketoacidosis, lower limb amputation risk, and Fournier’s gangrene, which are considered high-priority safety communications.
Report any unusual symptoms or side effects to your healthcare provider. You may also report side effects to the FDA at 1-800-FDA-1088 or via their website.
Lower Limb Amputation
While not as strongly linked to ertugliflozin as it was to canagliflozin, a risk of lower limb amputation (primarily of the toes) exists. Before starting, tell your doctor if you have a history of amputations, heart disease, or circulation problems in your legs. Check your feet daily for redness, sores, or infections.
Volume Depletion and Hypotension
Ertugliflozin causes 'osmotic diuresis,' meaning it pulls water out of the body along with glucose. This can lead to dehydration, especially in patients already taking diuretics (water pills) or those with low blood pressure. Symptoms include dizziness when standing up. Ensure you are drinking enough water, especially in hot weather or during exercise.
Genital Mycotic Infections
Because glucose is present in the urine, yeast can grow more easily. Both men and women are at risk. Practice good hygiene and contact your doctor if you notice itching or discharge.
Monitoring Requirements
To ensure the safe use of ertugliflozin, your healthcare provider will require regular monitoring of the following:
Renal Function (eGFR): Checked before starting and at least annually thereafter. More frequent monitoring is needed if your eGFR is near 45.
Volume Status: Physical exams to check for signs of dehydration (e.g., skin turgor, blood pressure).
Blood Glucose and HbA1c: To evaluate the effectiveness of the treatment.
LDL Cholesterol: Periodic lipid panels may be performed.
Foot Exams: Regular inspection of the feet for any signs of injury or infection.
Driving and Operating Machinery
Ertugliflozin itself does not usually cause drowsiness. However, if it is used in combination with insulin or a sulfonylurea, it can cause hypoglycemia (low blood sugar), which may impair your ability to drive or operate machinery. Additionally, if you experience dizziness due to low blood pressure, avoid these activities until the symptom resolves.
Alcohol Use
Alcohol can increase the risk of ketoacidosis and hypoglycemia while taking ertugliflozin. It can also contribute to dehydration. Patients are advised to limit alcohol consumption and discuss their habits with their doctor. Excessive 'binge drinking' is particularly dangerous for patients on SGLT2 inhibitors.
Discontinuation
If you are scheduled for surgery, your doctor will likely tell you to stop taking ertugliflozin at least 3 to 4 days before the procedure to reduce the risk of ketoacidosis. Do not restart the medication until you are eating normally and your doctor gives the 'all clear.'
> Important: Discuss all your medical conditions, including any history of pancreas problems, kidney disease, or frequent urinary tract infections, with your healthcare provider before starting Ertugliflozin Pidolate.
Management: Your doctor may need to lower your dose of insulin or sulfonylurea when you start ertugliflozin.
Diuretics (e.g., Furosemide, Hydrochlorothiazide)
Mechanism: Both drugs increase urine output and can lead to fluid loss.
Consequence: Increased risk of severe dehydration, electrolyte imbalance, and acute kidney injury.
Management: Monitor blood pressure and hydration status closely. Dose adjustments of the diuretic may be necessary.
Moderate Interactions
Lithium
Mechanism: SGLT2 inhibitors can increase the renal clearance of lithium.
Consequence: Reduced blood levels of lithium, potentially making it less effective for treating bipolar disorder.
Management: Monitor serum lithium levels more frequently when starting or stopping ertugliflozin.
UGT Inducers (e.g., Rifampin, Phenytoin)
Mechanism: These drugs can speed up the metabolism of ertugliflozin via the UGT pathway.
Consequence: Reduced efficacy of ertugliflozin, leading to higher blood sugar levels.
Management: Monitor blood glucose levels closely; a dose increase to 15 mg may be required.
Food Interactions
High-Fat Meals: While a high-fat meal slightly delays the time it takes for the drug to reach peak levels, it does not change the overall amount of drug absorbed. Therefore, it can be taken with or without food.
Caffeine: Excessive caffeine can worsen the diuretic effect (increased urination) and contribute to dehydration.
Hydration: It is not a drug interaction, but 'interaction' with water is critical. Dehydration significantly increases the risk of renal side effects.
Herbal/Supplement Interactions
St. John’s Wort: This herbal supplement is a known inducer of various metabolic enzymes and may potentially reduce the levels of ertugliflozin, though specific studies are lacking.
Natural Diuretics: Herbs like dandelion, juniper, or parsley may increase the risk of dehydration when combined with ertugliflozin.
Glucosamine: Some studies suggest glucosamine might interfere with blood sugar control, potentially counteracting the effects of diabetes medications.
Lab Test Interactions
Urine Glucose Test: Because ertugliflozin works by dumping glucose into the urine, a 'dipstick' urine glucose test will always be positive. This is expected and does not indicate a problem.
1,5-Anhydroglucitol (1,5-AG) Assay: This specific blood test for glucose control is unreliable in patients taking SGLT2 inhibitors. Use HbA1c or standard blood glucose monitoring instead.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. Even 'natural' products can change how your body processes ertugliflozin.
Relative Contraindications
In these situations, a healthcare provider must carefully weigh the risks against the benefits:
History of Diabetic Ketoacidosis (DKA): Patients prone to ketoacidosis are at much higher risk of developing it again while on an SGLT2 inhibitor.
Frequent Genital or Urinary Infections: Patients with a history of chronic yeast infections or recurrent UTIs may find these conditions worsen significantly.
Low Bone Mineral Density: Due to potential (though debated) risks of fractures, patients with severe osteoporosis should be treated with caution.
Peripheral Vascular Disease: Patients with poor circulation or foot ulcers are at higher risk for complications that could lead to amputation.
Hypovolemia: Patients who are already dehydrated or have very low blood pressure should have these conditions corrected before starting the drug.
Cross-Sensitivity
While there is no documented cross-reactivity between SGLT2 inhibitors and other classes of diabetes drugs (like metformin or DPP-4 inhibitors), patients who have had an allergic reaction to other gliflozins (e.g., canagliflozin, dapagliflozin) should be monitored extremely closely, as the chemical structures are related.
> Important: Your healthcare provider will evaluate your complete medical history, including your kidney function and history of infections, before prescribing Ertugliflozin Pidolate.
: It is not known if ertugliflozin is excreted in human breast milk. However, animal studies have shown the drug is present in the milk of lactating rats.
Risk to Infant: Because of the potential for serious adverse reactions in the nursing infant—specifically related to kidney development—breastfeeding is not recommended while taking ertugliflozin.
Pediatric Use
Age Range: Ertugliflozin is not approved for anyone under the age of 18.
Safety Concerns: The long-term effects of SGLT2 inhibition on growth and renal development in children are unknown. Type 2 diabetes in children is typically managed with metformin or insulin as first-line therapies.
Geriatric Use
Risks: Patients aged 65 and older are at a higher risk for volume depletion (dehydration) and hypotension.
Renal Function: Since kidney function naturally declines with age, elderly patients are more likely to fall into the eGFR < 45 category where the drug is not recommended.
Polypharmacy: Older adults are often taking diuretics or blood pressure medications, which increases the risk of drug interactions.
Renal Impairment
Dosing: Effectiveness is lost as kidney function declines.
Monitoring: eGFR must be checked at least once a year. If eGFR falls below 45, the drug should be stopped. It is strictly contraindicated if eGFR is below 30.
Hepatic Impairment
Mild to Moderate: No adjustment needed.
Severe: Use is not recommended as it has not been studied in this population. The liver plays a role in the glucuronidation of the drug, and severe failure could lead to unpredictable drug levels.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are planning to become pregnant or are over the age of 65.
HbA1c Reduction
: Clinical trials show an average HbA1c reduction of 0.7% to 1.0% when used as monotherapy.
Pharmacokinetics
| Parameter | Value |
|---|---|
| Bioavailability | ~100% |
| Protein Binding | 93.6% |
| Half-life | ~16.6 hours |
| Tmax | ~1 hour (fasted) |
| Metabolism | UGT1A9 and UGT2B7 (Glucuronidation) |
| Excretion | Renal 50.2%, Fecal 40.9% |
Chemical Information
Molecular Formula: C27H33NO10 (as pidolate salt)
Molecular Weight: 531.55 g/mol
Solubility: Soluble in ethanol and acetone; slightly soluble in water.
Structure: It is a C-glycoside derivative. The pidolate form is the L-pyroglutamic acid salt of ertugliflozin.
Drug Class
Ertugliflozin belongs to the SGLT2 inhibitor class. Other medications in this class include:
Empagliflozin (Jardiance)
Dapagliflozin (Farxiga)
Canagliflozin (Invokana)
Unlike metformin (which works in the liver) or sulfonylureas (which work in the pancreas), SGLT2 inhibitors work exclusively via the kidneys.