SGLT-2 Inhibitors: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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Sodium-glucose cotransporter-2 inhibitors, or SGLT-2 inhibitors, have been rigorously studied in clinical trials and found to be safe and effective at improving blood glucose levels in adults with type 2 diabetes mellitus (T2DM). The first SGLT-2 inhibitor approved by the U.S. Food and Drug Administration (FDA) was Invokana (canagliflozin) in March 2013. These medications can be used along with diet and exercise as monotherapy or in combination with other oral or injectable diabetes medications. In addition to improving blood glucose control, SGLT-2 inhibitors can also reduce body weight and systolic and diastolic blood pressure. SGLT-2 inhibitors are not indicated for the treatment of type 1 diabetes mellitus (T1DM).

The list below includes the most common SGLT-2 inhibitors, combination products containing SGLT-2 inhibitors, and their pricing:

List of SGLT-2 inhibitors

What are SGLT-2 inhibitors?

SGLT-2 inhibitors are a class of medications that block the reabsorption of blood glucose in the kidneys. They were originally developed as an oral antidiabetic treatment for adults with T2DM. Clinical trials soon showed that SGLT-2 inhibitors improve kidney function in adults with diabetes who had diabetic nephropathy. They also reduce the risk of cardiovascular mortality and hospitalization from heart failure.

How do SGLT-2 inhibitors work?

SGLT-2 inhibitors, which are also called gliflozins, lower blood sugar levels by inhibiting the sodium-glucose transport protein 2 in the renal tubules in the kidneys. SGLT2 inhibition blocks the reabsorption of filtered glucose in the kidneys and increases the excretion of glucose in the urine.

The cardiovascular benefits of SGLT-2 inhibitors are unlikely due to the blood glucose lowering mechanism of action. It is thought to be due to a combination of reduced plasma volume, reduced blood pressure, increased production of ketones in the liver, deactivation of the renin-angiotensin-aldosterone system, and a decrease in tissue inflammation. A systematic review and meta-analysis of randomized, placebo-controlled, cardiovascular outcome trials in patients with type 2 diabetes showed that SGLT-2 inhibitors reduced the risk of death from cardiovascular events (heart attack, stroke).

What conditions are SGLT-2 inhibitors used to treat?

SGLT-2 inhibitors are FDA-approved to:

• Reduce the risk of cardiovascular death and hospitalization from heart failure in adults with reduced ejection fraction.
• Reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and cardiovascular disease or risk factors such as hypertension and obesity.
• Improve glycemic control in adults with type 2 diabetes mellitus along with diet and exercise.
• Reduce the risk of eGFR (estimated glomerular filtration rate) decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease.

Are SGLT-2 inhibitors safe?

When taken as prescribed, SGLT-2 inhibitors can be safe and effective. They can cause some serious side effects, which can worsen some medical conditions. Make sure to tell your healthcare provider about all of your health conditions, including:

• Kidney disease
• Liver disease
• History of genital infections
• History of urinary tract infections
• Pancreatitis
• Type 1 diabetes
• Are pregnant or plan on becoming pregnant
• Are breastfeeding or plan on breastfeeding

Your healthcare provider should also be aware of the prescription drugs, over-the-counter medications, and supplements you are taking, including:

• Diuretics
• Insulin or other medications used to treat hyperglycemia (high blood sugar)

Can you take SGLT-2 inhibitors while you are pregnant or breastfeeding?

Based on animal reproduction studies showing adverse renal effects, SLGT-2 inhibitors are not recommended during the second and third trimesters of pregnancy.

There is limited information on whether SGLT-2 inhibitors are found in breast milk and the effects they might have. Since there is a potential for adverse effects in a breastfed infant, SGLT-2 inhibitor use is not recommended during lactation.

What are the common side effects of SGLT-2 inhibitors?

Some common side effects of SGLT-2 inhibitors include:

• Hyperkalemia (high potassium levels)
• Increased risk of hypoglycemia (low blood sugar), especially if taken with other diabetes medicines
• Nausea
• Dehydration
• Increased urination
• Increased cholesterol
• Constipation
• Fatigue
• Weight loss

SGLT-2 inhibitors can sometimes cause severe adverse effects, including:

• Diabetic ketoacidosis (DKA)
• Serious genital infections (Fournier’s gangrene)
• Pancreatitis
• Kidney injury
• Urinary tract infections (UTIs)
• Hypersensitivity reactions, including anaphylaxis
• Increased risk of bone fractures and lower limb amputation with Invokana (canagliflozin)

This is not a complete list of side effects and we encourage you to consult with your healthcare provider for medical advice about any possible side effects.

How much do SGLT-2 inhibitors cost?

SGLT-2 inhibitors are very expensive with an average cost of around $10,000 per year.

You can purchase SGLT-2 Inhibitors for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.

Related resources for SGLT-2 inhibitors

• Sodium-glucose transport protein 2 (SGLT2) inhibitors. National Library of Medicine, Stat Pearls
• SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nature.com
• SGLT2 inhibitors overview. National Kidney Foundation
• SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes. The Lancet
• Story of discovery: SGLT2 inhibitors: harnessing the kidneys to help treat diabetes. National Institute of Diabetes and Digestive and Kidney Diseases.
• Information on SGLT2 Inhibitors. FDA