SGLT2 inhibitors

About SGLT2 inhibitors

What are SGLT2 inhibitors?

SGLT2 inhibitors are medicines used to treat heart failure. They can help:

• improve symptoms like breathlessness, fatigue and swelling
• reduce the risk of your condition getting worse
• reduce the need to be admitted to hospital.

They’re also used to treat other conditions, such as:

• type 2 diabetes
• chronic kidney disease.

This medicine is not recommended if you have type 1 diabetes.

SGLT2 stands for called sodium-glucose co-transporter-2.

How do SGLT2 inhibitors work?

SGLT2 inhibitors help your kidneys to remove excess fluid, salt and glucose (sugar) from your body. These are then passed out of your body when you pee.

Originally developed as a treatment for diabetes, it was later discovered that some SGLT2 inhibitors are an effective treatment for heart failure and chronic kidney disease.

Studies have not shown exactly how they help. But SGLT2 inhibitors have been proven to improve heart failure symptoms, like swollen ankles and breathlessness. Studies also show that people with heart failure who take this medicine are less likely to be admitted to hospital.

Types of SGLT2 inhibitors

What are the different types of SGLT2 medicines?

There are several different types of SGLT2 inhibitors. The ones recommended for heart failure are: 

• dapagliflozin (Forxiga)
• empagliflozin (Jardiance).

If you have diabetes and heart failure, your doctor can give you more information about managing your blood sugars and the types of medicines they’re recommending. SGLT2 inhibitors may affect how other medicines work and cause side effects.

Side effects

What are the side effects of SGLT2 inhibitors?

Side effects from SGLT2 inhibitors may include:

• feeling thirsty more often than normal
• peeing more often than normal
• pee (urine) infections
• genital thrush infections
• weight loss.

If you notice any of these side effects, please do not stop taking your medicine but do discuss them with your doctor, nurse or pharmacist.

All medicines have potential side effects, but most people will not experience side effects.

When should I get help?

Serious side effects from SGLT2 inhibitors are rare. But it’s important to be aware of them in case you need to get help. This includes:

Diabetic ketoacidosis

Diabetic ketoacidosis is a rare but serious condition where harmful substances called ketones build up in your blood. It can happen even if your blood sugars are normal.

Symptoms include:

• tummy (stomach) pain
• feeling or being sick
• rapid breathing or deep sighing breaths
• dehydration and feeling very thirsty
• feeling very sleepy (drowsy) and tired
• feeling confused.

This condition requires urgent medical treatment. If you are worried that you may have diabetic ketoacidosis you should go to your nearest A&E department.

Fournier’s gangrene

Fournier’s gangrene is a rare but serious infection that affects the genitals or the area between the genitals and the bottom.

Call 999 or go to your nearest A&E department if you have:

• redness or swelling in your genital area or between the genitals and bottom
• and a temperature (38C or higher) or you’re feeling generally unwell.

How and when to take them

How and when do I take this medicine?

SGLT2 inhibitors are taken as a tablet, once a day. Try and take it at the same time every day.

Your doctor will give you more information about the type of SGLT2 inhibitor they’re giving you and how to take it. You can also speak to your local pharmacist if you have questions about your medicine.

Are there times when I should stop taking SGLT2 inhibitors?

The risk of diabetic ketoacidosis and dehydration are higher if you take this medicine when you’re not eating and drinking normal amounts.

For this reason, it’s recommended that you do not take your medicine if you’re:

• not eating or drinking before an operation or procedure (fasting)
• not eating or drinking because you’re unwell
• unwell with an infection or other illness
• drinking large amounts of alcohol.

If you’re fasting during Ramadan and you’re diabetic, you may want to change the time when you take your medicine. You could take it at Iftar. You may need to consider a medical exemption from fasting if you have significant or unstable symptoms of heart failure, especially if you’re on a high dose of diuretics.

Check with your doctor when you may need to stop or restart your medicine. Usually that will be when you're recovered and eating and drinking normally.

What happens if I forget to take my medicine?

If you forget to take your medicine and:

• It's only a short time after your usual dose, take it as soon as you remember. Then take your next dose at the usual time.  
• It’s nearly time for your next dose, do not take the one you missed. Wait and take your next dose at the usual time. 

Things to avoid

What should I avoid if I am taking SGLT2 inhibitors?

You should avoid:

• not eating or drinking (fasting)
• low carbohydrate (ketogenic) diets.

Speak to your doctor, nurse or pharmacist for a full list of foods and medicines to avoid.

You should not take SGLT2 inhibitors if you’re pregnant. If you’re currently taking SGLT2 inhibitors and you’re planning to get pregnant or you become pregnant, speak to your doctor.

Get help with SGLT2 inhibitors

• Our cardiac nurses can help answer your questions on SGLT2 inhibitors, Call, email or live chat with them on our Heart Helpline.
• Check if you can get free prescriptions or help paying for your prescriptions.
• Talk to other people with heart failure and get support in our online community.