SGLT2 Inhibitors (Gliflozins) – Important Information for Patients
What are SGLT2 inhibitors?
SGLT2 inhibitors are medicines that help treat:
- Type 2 diabetes
- Chronic kidney disease (CKD)
- Heart failure
Common examples include:
- Dapagliflozin (Forxiga®)
- Empagliflozin (Jardiance®)
- Canagliflozin (Invokana®)
- Ertugliflozin (Steglatro®)
These medicines work by helping your body remove excess glucose through the urine. They can also help protect your heart and kidneys.
Common side effects
Passing urine more often and dehydration
These medicines can make you pass more urine.
To reduce the risk of dehydration:
- Drink enough fluids throughout the day
- Seek advice if you feel dizzy, light-headed or unusually thirsty
Genital thrush or fungal infections
Because there is more glucose in the urine, some people develop thrush around the genital area.
Symptoms may include:
- Itching
- Soreness
- Redness
- Irritation
These infections are usually easy to treat. Speak to your pharmacist or GP if symptoms occur.
Low blood sugar (hypoglycaemia)
SGLT2 inhibitors do not usually cause low blood sugar on their own.
The risk is higher if you also take insulin or certain other diabetes medications.
Rare but serious side effects
Diabetic ketoacidosis (DKA)
Very rarely, SGLT2 inhibitors can cause a build-up of acids called ketones in the blood.
Symptoms include:
- Feeling sick or vomiting
- Stomach pain
- Excessive thirst
- Rapid breathing
- Dizziness
- Breath that smells sweet, fruity or like nail varnish remover
Seek urgent medical attention if these symptoms develop.
The risk is increased if you:
- Are fasting
- Have a severe illness
- Become dehydrated
- Drink excessive alcohol
- Follow a very low-carbohydrate or ketogenic diet
Fournier's gangrene
This is an extremely rare but serious infection affecting the genital area or the skin between the genitals and back passage.
Seek urgent medical attention if you develop:
- Severe pain
- Swelling
- Redness or tenderness in the genital area
- Fever or feeling generally unwell
Please tell the healthcare professional that you are taking an SGLT2 inhibitor.
Foot problems
If you have:
- An active foot ulcer
- Severe circulation problems in your legs or feet
Please discuss this with your GP, nurse or specialist, as this medicine may not be suitable for you.
Sick Day Rules – When should I stop taking my SGLT2 inhibitor?
Temporarily stop taking your SGLT2 inhibitor if you are unwell with:
- Vomiting
- Diarrhoea
- Fever
- Significant dehydration
You should also stop it:
- Before surgery or procedures where you need to fast
- If you are unable to eat or drink normally
If you have diabetes, continue monitoring your blood glucose levels more frequently.
Do not stop insulin unless advised by a healthcare professional.
You can usually restart your SGLT2 inhibitor once you have been eating and drinking normally for 24–48 hours.
If you remain unwell after 48 hours, seek medical advice.
When should I seek help?
Contact Brookfield Surgery, NHS 111, or seek urgent medical attention if you:
- Develop symptoms of ketoacidosis
- Have signs of Fournier's gangrene
- Become severely dehydrated
- Have concerns about side effects or whether you should continue your medication
If you are unsure whether to stop or restart your medication, please contact the surgery for advice.