Ertugliflozin

Ertugliflozin is an oral antidiabetic medication in the class of sodium-glucose cotransporter 2 (SGLT2) inhibitors. It is marketed under the brand name Steglatro and was developed for use in adults with type 2 diabetes mellitus to improve glycemic control, either as monotherapy or in combination with other antidiabetic agents, alongside diet and exercise.

Mechanism of action and pharmacology: Ertugliflozin selectively inhibits SGLT2 in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. The resulting glucosuria lowers plasma glucose and is associated with modest reductions in HbA1c, as well as small decreases in body weight and blood pressure. The medication is taken once daily by mouth, with or without food.

Indications and dosing: The usual starting dose is 5 mg once daily, which may be increased to 15 mg once daily after at least four weeks if additional glycemic control is needed and tolerated. In patients with renal impairment, the glucose-lowering efficacy declines, and dosing decisions should consider renal function. Ertugliflozin is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis. It should be used with caution in patients at risk of dehydration or volume depletion, and interactions with other agents that affect volume status or glucose levels should be considered.

Safety and adverse effects: Common adverse events include genital fungal infections and urinary tract infections. Volume depletion can lead to dizziness or orthostatic symptoms. Hypoglycemia risk increases when combined with insulin or insulin secretagogues. Rare cases of diabetic ketoacidosis and acute kidney injury have been reported. Use is generally avoided in pregnancy due to limited data, and safety in pediatric patients is not established.