The Food and Drug Administration (FDA) has approved safety labeling changes for sodium glucose co-transporter-2 (SGLT2) inhibitors. These include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. 

As surgery may put patients at increased risk of developing ketoacidosis, the FDA has approved the following labeling changes for this class of drugs:

  • Canagliflozin (Invokana; Janssen), dapagliflozin (Farxiga; AstraZeneca), and empagliflozin (Jardiance; Boehringer Ingelheim and Lilly) should each be temporarily discontinued at least 3 days prior to scheduled surgery.
  • Ertugliflozin (Steglatro; Merck) should be temporarily discontinued at least 4 days prior to scheduled surgery.
  • Blood glucose levels should be carefully monitored following discontinuation of the SGLT2 inhibitor and managed appropriately prior to surgery.

“The SGLT2 inhibitor may be restarted once the patient’s oral intake is back to baseline and any other risk factors for ketoacidosis are resolved,” the agency stated in the release.

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Other factors that may predispose patients to ketoacidosis include insulin dose reduction, acute febrile illness, reduced caloric intake, pancreatic disorders suggesting insulin deficiency, and alcohol abuse. 

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This article originally appeared on MPR