Ertugliflozin


Concise Prescribing Info
Indications/Uses
Type 2 diabetes mellitus.
Dosage/Direction for Use
Adult : PO Monotherapy or combined with other antidiabetic agents: Initial: 5 mg once daily in the morning, may be increased up to 15 mg once daily if necessary.
Dosage Details
Oral
Type 2 diabetes mellitus
Adult: As monotherapy or in combination with other antidiabetic agents: Initially, 5 mg once daily in the morning, may be increased up to 15 mg once daily if necessary. Correct volume depletion prior to treatment initiation, if present.
Renal Impairment
eGFR 30-<60 mL/minute/1.73 m2: Not recommended; eGFR <30 mL/minute/1.73 m2, ESRD or undergoing dialysis: Contraindicated.
Hepatic Impairment
Severe (Child-Pugh class C): Not recommended.
Administration
Tab: May be taken with or without food.
Contraindications
Diabetic ketoacidosis. Severe renal impairment (eGFR <30 mL/minute/1.73 m2), ESRD, or patients on haemodialysis.
Special Precautions
Patient with history of genital mycotic infections, hypotension, CV disease; risk factors predisposing to ketoacidosis (e.g. pancreatic insulin deficiency, history of pancreatitis, dose decreases of insulin, caloric restriction, dehydration, alcohol abuse, acute febrile illness, pancreatic surgery); risk factors for amputation (e.g. prior amputation, peripheral vascular disease, neuropathy, diabetic foot ulcers); risk factors for acute kidney injury (e.g. hypovolaemia, chronic renal insufficiency, CHF); undergoing bariatric surgery. Uncircumcised males. Not recommended for treatment of type 1 diabetes mellitus. Temporarily discontinue therapy ≥4 days before surgery or any event that may precipitate ketoacidosis. Hepatic and mild to moderate renal impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Bone fractures, genital mycotic infections (e.g. vulvovaginal candidiasis, vulvovaginitis, candidal balanitis, balanoposthitis), hypotension, volume depletion, lower limb amputation (mainly of the toe), acute renal injury, impaired renal function (e.g. decreased eGFR, increased serum creatinine), increased LDL-cholesterol (LDL-C), serious UTIs including urosepsis and pyelonephritis.
Investigations: Increased Hb and BUN; changed serum lipids, weight decreased.
Metabolism and nutrition disorders: Hypoglycaemia, thirst.
Musculoskeletal and connective tissue disorders: Back pain.
Nervous system disorders: Headache.
Renal and urinary disorders: Increased urination.
Reproductive system and breast disorders: Vulvovaginal pruritus.
Respiratory, thoracic and mediastinal disorders: Nasopharyngitis.
Potentially Fatal: Rarely, diabetic ketoacidosis, Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum).
Patient Counseling Information
This drug may increase your risk of lower limb amputations; it is important to adhere with your routine preventive foot care.
MonitoringParameters
Monitor blood glucose, HbA1c (at least twice yearly in patients with stable glycaemic control; quarterly in patients not meeting treatment goals); renal function at baseline and periodically during therapy; phosphate and LDL-C; volume status (e.g. blood pressure, haematocrit, electrolytes). Assess for signs of genital mycotic infections, UTIs, lower limb and feet sores, ulcers, or infection; hypersensitivity reactions. Confirm signs and symptoms of ketoacidosis (e g. nausea, vomiting, abdominal pain, malaise, shortness of breath) by measuring blood ketones and arterial pH.
Drug Interactions
Increased risk of hypoglycaemia with insulin and sulphonylurea. May increase risk of hypotension and dehydration with diuretics.
Lab Interference
May give positive test result for glucosuria. May interfere with glycaemic control monitoring using 1,5-anhydroglucitol (1,5-AG) assay.
Action
Description: Ertugliflozin is a potent, selective, and reversible inhibitor of sodium-glucose co-transporter 2 (SGLT2), the main transporter responsible for filtered glucose reabsorption in the renal proximal convoluted tubules. It reduces renal reabsorption of filtered glucose and lowers renal threshold for glucose, resulting in increased urinary glucose excretion.
Pharmacokinetics:
Absorption: Bioavailability: Approx 100%. Time to peak plasma concentration: Approx 1 hour (fasting); 2 hours (with high-fat, high-calorie meal).
Distribution: Volume of distribution: 85.5 L. Plasma protein binding: Approx 94%.
Metabolism: Extensively metabolised primarily by uridine diphosphate glucuronosyltransferases (UGT)1A9 and UGT2B7 via O-glucuronidation into inactive metabolites; undergoes minimal metabolism by CYP450 isoenzyme.
Excretion: Via urine (approx 50%; 1.5% as unchanged drug); faeces (approx 41%; approx 34% as unchanged drug). Elimination half-life: Approx 17 hours.
Chemical Structure

Chemical Structure Image
Ertugliflozin

Source: National Center for Biotechnology Information. PubChem Database. Ertugliflozin, CID=44814423, https://pubchem.ncbi.nlm.nih.gov/compound/Ertugliflozin (accessed on Apr. 27, 2020)

Storage
Store between 15-30°C. Protect from moisture.
MIMS Class
ATC Classification
A10BK04 - ertugliflozin ; Belongs to the class of sodium-glucose co-transporter 2 (SGLT2) inhibitors. Used in the treatment of diabetes.
References
Anon. Ertugliflozin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/04/2020.

Buckingham R (ed). Ertugliflozin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/04/2020.

FDA Revises Labels of SGLT2 Inhibitors for Diabetes to Include Warnings About Too Much Acid in The Blood and Serious Urinary Tract Infections. U.S. FDA. https://www.fda.gov/. Accessed 22/04/2020.

Joint Formulary Committee. Ertugliflozin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/04/2020.

Steglatro 5, 15 mg Film-Coated Tablets (Merck Sharp & Dohme [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my/. Accessed 02/04/2020.

Steglatro Tablet, Film Coated (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/04/2020.

Disclaimer: This information is independently developed by MIMS based on Ertugliflozin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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