SGLT-2 inhibitors are a class of drugs that are used primarily to manage type 2 diabetes. They work by inhibiting sodium-glucose co-transporter 2 (SGLT-2), a protein in the kidneys that plays a role in reabsorbing glucose back into the bloodstream.

By inhibiting SGLT-2, these drugs allow excess glucose to be excreted in urine, thereby reducing blood glucose levels. However, like all drugs, SGLT-2 inhibitors are associated with a range of adverse effects, some of which can be serious.

In this article, we’ll discuss the adverse effects of SGLT-2 inhibitors and what you need to know about them if you’re taking or considering taking these drugs.

Common Adverse Effects

Like most drugs, SGLT-2 inhibitors can cause some common side-effects in some patients. According to various studies, the most common side-effects of SGLT-2 inhibitors include:.

Genital and urinary tract infections
Dehydration
Hypotension or Low Blood Pressure
Increased potassium levels in the blood (hyperkalemia)
Constipation and Diarrhea
Nausea and vomiting
increased risk of fractures

Genital and Urinary Tract Infections

One of the most common adverse effects of SGLT-2 inhibitors is an increased risk of genital and urinary tract infections. SGLT-2 inhibitors work by reducing blood glucose levels by increasing the amount of glucose excreted in the urine.

The increased glucose in the urine can promote bacterial growth, leading to an increased risk of urinary tract infections and genital infections in both men and women.

Genital and urinary tract infections include symptoms such as pain or burning with urination, frequent urination, cloudy or strong-smelling urine, vaginal itching or discharge, and painful intercourse.

In most cases, these infections can be treated with antibiotics. However, if left untreated, they can cause serious complications, such as kidney infections or sepsis.

Dehydration

SGLT-2 inhibitors can cause dehydration by increasing urine output, which can lead to a loss of water and electrolytes from the body. Symptoms of dehydration include dizziness, fatigue, dry mouth, and decreased urine output.

In severe cases, dehydration can lead to kidney failure, a medical emergency.

Hypotension or Low Blood Pressure

SGLT-2 inhibitors can lower blood pressure, potentially causing dizziness, weakness or lightheadedness, or even fainting.

If you’re taking medications for high blood pressure, it’s essential to monitor your blood pressure when starting SGLT-2 inhibitor therapy to ensure it doesn’t drop too low and cause symptoms associated with low blood pressure.

Increased potassium levels in the blood (hyperkalemia)

SGLT-2 inhibitors can cause a buildup of potassium in the blood, a condition called hyperkalemia. Symptoms of hyperkalemia include muscle weakness, fatigue, and an irregular heartbeat.

Severe cases of hyperkalemia can be life-threatening and require immediate medical attention. This risk is higher in patients with pre-existing kidney disease.

Constipation and Diarrhea

SGLT-2 inhibitors cause an osmotic diuretic effect in patients, which can lead to diarrhea, and it helps to reduce constipation. While these side-effects are generally mild and resolve on their own, they can be unpleasant for some patients.

Nausea and vomiting

Canagliflozin, an SGLT-2 inhibitor, in particular, is associated with an increased risk of nausea and vomiting. These symptoms usually resolve on their own with time, but in severe cases, medication may be required to relieve the symptoms.

Increased risk of fractures

A study by the US Food and Drug Administration found that patients taking canagliflozin had an increased risk of bone fractures. It is believed that these fractures may be due to the drug’s effects on bone mineral density.

The risk of fractures was higher in elderly patients with pre-existing risk factors for fractures.

Serious Adverse Effects

In rare cases, SGLT-2 inhibitors can cause more severe adverse effects. These include:.

Ketoacidosis
Acute kidney injury
Necrotizing fasciitis of the perineum (Fournier’s gangrene)

Ketoacidosis

Ketoacidosis is a rare but severe complication that can occur in patients taking SGLT-2 inhibitors. This condition occurs when the body produces too many ketones from the breakdown of fat, which can cause the blood to become too acidic.

Symptoms of ketoacidosis include nausea, vomiting, abdominal pain, and confusion. In severe cases, ketoacidosis can lead to a coma or even death. Patients taking SGLT-2 inhibitors should be closely monitored for the signs of ketoacidosis, particularly if they have a history of diabetes or have recently undergone surgery.

Acute Kidney Injury

Acute kidney injury is another rare but potentially severe adverse effect of SGLT-2 inhibitors. This condition occurs when the kidneys suddenly stop working correctly and can’t filter waste from the body.

Symptoms of acute kidney injury include swelling in the feet or ankles, decreased urine output, fatigue, confusion, and shortness of breath. Patients with pre-existing kidney problems or those who are dehydrated are at higher risk of developing acute kidney injury while taking SGLT-2 inhibitors.

Necrotizing Fasciitis of the perineum (Fournier’s Gangrene)

Necrotizing fasciitis of the perineum, a rare but life-threatening infection, has been associated with SGLT-2 inhibitors. Symptoms of this condition include severe pain, fever, and swelling in the genital area.

In severe cases, the infection can lead to sepsis or even death. In some cases, patients require surgical intervention to remove the infected tissue. Patients who experience symptoms of this infection should seek emergency medical attention.

Conclusion

SGLT-2 inhibitors are a class of drugs that can help patients manage blood glucose levels. However, like all drugs, they are associated with a range of adverse effects, some of which can be severe.

Patients who are taking SGLT-2 inhibitors should be aware of the possible side-effects and seek medical attention if they experience any symptoms. Overall, SGLT-2 inhibitors are an effective treatment option for managing diabetes, but it’s essential to weigh the risks and benefits and work closely with your healthcare provider to ensure the best possible outcome.