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ALIMENTARY TRACT AND METABOLISM › DRUGS USED IN DIABETES › BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS › Combinations of oral blood glucose lowering drugs
metformin and ertugliflozin
A10BD23
Forms & Strengths
- Metformin HCl / Ertugliflozin 500 mg / 2.5 mg oral tablet
- Metformin HCl / Ertugliflozin 500 mg / 7.5 mg oral tablet
- Metformin HCl / Ertugliflozin 1000 mg / 2.5 mg oral tablet
- Metformin HCl / Ertugliflozin 1000 mg / 7.5 mg oral tablet
Adult Dosing
- Initial dose based on current regimen: usually 500 mg metformin / 2.5 mg ertugliflozin twice daily
- Max daily dose: 2000 mg metformin / 15 mg ertugliflozin
- Take with meals to reduce gastrointestinal side effects associated with metformin
- Assess renal function prior to initiation and periodically thereafter
Pediatric Dosing
- Safety and efficacy in pediatric patients below 18 years of age have not been established
- Not recommended for use in children or adolescents
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
- Indicated when treatment with both metformin and ertugliflozin is appropriate
Mechanism of Action
- Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity
- Ertugliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor, reducing renal glucose reabsorption and lowering the renal threshold for glucose
Contraindications
- Estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73m2 or end-stage renal disease
- Active or chronic metabolic acidosis, including diabetic ketoacidosis
- History of serious hypersensitivity reaction to metformin or ertugliflozin
Adverse Reactions
- Genital mycotic infections
- Urinary tract infections
- Diarrhea, nausea, and abdominal discomfort
- Hypoglycemia (when used with insulin or insulin secretagogues)
- Volume depletion and hypotension
- Lactic acidosis (rare associated with metformin)
Drug Interactions
- Intravascular iodinated radiocontrast agents increase risk of acute kidney injury and metformin-associated lactic acidosis
- Diuretics may potentiate the risk of dehydration and hypotension associated with SGLT2 inhibition
- Insulin and insulin secretagogues increase the risk of hypoglycemia
- Drugs that reduce metformin clearance (e.g., cimetidine) may increase systemic exposure
Curated Content: Needs Vetting Before Put to Clinical Use