Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-39

Empagliflozin (Jardiance ® ) • TDD: 10 mg- 25 mg • Frequency: QD • Taken at any time. Dosing schedule • Initiate at 10 mg QD. • Titrate dose to 25 mg if

Caution • eGFR < 45mL/min/1.73m 2 : reduced glycemic-lowering efficacy Contraindicated • dialysis

tolerating well and BG not in target.

• Available: 10 mg, 25 mg

Dose that has demonstrated cardiorenal benefits: • empagliflozin 10mg

Canagliflozin (Invokana ® ) • TDD: 100 mg- 300 mg • Frequency: QD • Taken at any time. Dosing schedule • Initiate at 100 mg QD. • Titrate to 300 mg if BG not in target, eGFR ≥6 0 mL/min/1.73m 2 and low risk of adverse reactions associated with reduced intravascular volume. • Available: 100 mg, 300 mg

Adverse effects • Increased rates of genital infections/volume depletion. • Reports of acute kidney injury. • CANVAS trial: 26% increased rate of bone fracture and 1.97 fold increased risk of amputation (71% toe/metatarsal; 29% ankle/knee). • Highest risk associated with history of prior amputation and peripheral vascular disease. • Number Needed to Harm: 323/27 (89,90) Health-care professionals advisory: FDA Drug Safety Communication May 18, 2016 • Assess lower limb amputation risk prior to initiation and monitor those at higher risk. Counsel on routine preventative foot care and adequate hydration. • Discontinue if lower- extremity skin ulcer, infection, osteomyelitis or gangrene. Contraindicated • People with history of prior amputation. • dialysis

Dose that has demonstrated cardiorenal benefits: • canagliflozin 100mg