Review of considerations with the use of empagliflozin and other SGLT-2 agents and developing a UTI
My name is tessa buer and today i’m talking about impaglaflozen and utis i am a pharmd candidate for 2021 at drake university so we’ll start off with the mechanism of action um this is for all of the sglt2 inhibitors so they inhibit the sodium glucose transporter too which inhibits the reabsorption of glucose these lead to the glucose excreting the body
Through the urine so as you can see in the graphic below the sgl t1 and sglt2 there’s about 10 percent of glucose resource reabsorption with sgl t1 and 90 occurs with sglt2 so we’re excreting about 90 of that glucose when we’re inhibiting that reabsorption so what are the consequences of this so there’s increased risk for uti there are hospitals there have been
Hospitalizations reported so um these have included the urosepsis which is sepsis um due to a urinary tract infection and pyelonephritis um it’s taken about 45 days for onset to occur with patients that have had these happen so not too terribly long we also need to think about our high-risk population so our elderly patients 75 years and older at a much higher
Risk they also um they also are at a higher risk for if they’re female so due to the anatomy of a female’s body versus a male there is more surface area for bacteria growth which leads to a higher risk for that urinary tract infection to occur additionally renal function is something that we are always thinking about as pharmacists and that as the the worse
Of their renal function is the higher incidence of the urinary tract infection could be to occur so this is something we definitely want to keep in mind as some of these agents um can be considered uh nephroprotective um we just want to make sure that we are keeping in mind that it also can um even though it might be nephroprotective increase the risk for that
Urinary tract infection as an adverse event um so there were um from the fda adverse event reporting service um there were quite a few or not quite a few there were a few that were reported for hospitalization there were 19 cases um and 15 of those 19 cases cases led to discontinuation of the sglt2 inhibitor so not necessarily only impact frozen but but canada
Goflozen or dapico flows in as well so things that we need to double check before initiation of the medication and then additionally continue to monitor while they’re on it so have they had a high history of urinary tract infections are the patients already at a higher risk if they have constantly been battling urinary tract infections throughout their entire
Life we maybe don’t want to initiate this medication because they’re only going to be at a higher risk because of that to undergo even more urinary tract infections additionally age as i talked about before so those greater than 75 are at a higher risk however those under 65 were also reported to have hospitalizations and urinary tract infections according to the
Fda adverse event reporting system and then additionally renal function so not only is this something that we monitor initially we don’t want to initiate this medic these medications in patients with an egfr less than 45 mils per minute however if their renal function is worsening on the medication it might be something to consider taking them off of because it’s
Only increasing that risk for the urinary tract infection and possible hospitalization thereafter so what is the best for the patient do we always discontinue do we keep them on it well that depends so if they’re hospitalized for that complicated uti we’re going to probably discontinue it they could be hospitalized for an aki due to this medication sepsis due to
The uti or pyelonephritis if it leads to a hospitalization it’s not worth it so that medication should be discontinued if the patient is treated outpatient for an uncomplicated uti and we’re relating it to the sglt2 inhibitor such as impagleflozen we need to kind of evaluate the patient on a case-by-case basis so was the uti resolved with antibiotics is this
The first incidence is it a recurrence is it worsening have they had more recurrences since the initiation of the sgl t2 based on the answers to these questions we would want to evaluate the patient and possibly discontinue therapy or choose another option so for clinical judgment pharmacists you’re always being the patient advocate so just always thinking about
Should the initiation can occur or should the therapy be continued so if the hospital is would they be rather rehospitalized for uncontrolled diabetes or hospitalized for uti well maybe we don’t need to be hospitalized for either one if they maybe shouldn’t be initiated on the medication are there other options can we avoid the adverse effect that may lead to
That hospitalization altogether and put them on a different medication maybe a dpp-4 or an sglt2 or insulin even these might be better options in some of our patients just due to the renal function and the adverse effects of those urinary tract infections we also just needed to be cognizant that if they have been hospitalized for uti and we can somehow relate
It to that stlt2 inhibitor such as empagliflozin we probably want to discontinue that option and have a new find a new diabetic regimen for that patient thanks for listening that’s all i had today hope you’re able to learn something
Transcribed from video
Empagliflozin and UTI Risk By IM_Pharm_APPE