Table 2.

Summary of licensed indications and recommended doses of sodium glucose co-transporter 2 inhibitors in type diabetes

Dose adjustment recommendations as per kidney functions
SGLT2 inhibitorLicensed indicationeGFR >60eGFR 45–59eGFR 30–44eGFR <30
CanagliflozinAdults with insufficiently controlled T2DInitiate 100 mg, titrate to 300 mg if neededInitiate / continue with 100 mg onlyInitiate / continue with 100 mg only if albuminuria >30 mg/mmol at initiationContinue established treatment with 100 mg but do not initiate; stop if dialysis/transplant
DapagliflozinAdults with insufficiently controlled T2DInitiate 10 mgContinue with 10 mg but do not initiateNot recommendedNot recommended
DapagliflozinHFrEF with or without T2DInitiate 10 mgInitiate 10 mgInitiate 10 mgLimited experience
EmpagliflozinAdults with insufficiently controlled T2DInitiate 10 mg, titrate to 25 mg if requiredContinue with 10 mg only; do not initiateNot recommendedNot recommended
ErtugliflozinGlycaemic control onlyInitiate 5 mg, titrate to 15 mg if neededContinue with 5 mg or 15 mg; do not initiateNot recommendedNot recommended
In appropriate high-risk patients, a decision to treat with an SGLT2 inhibitor to reduce risk of cardiovascular, kidney and/or heart failure events should be considered independent of HbA1c.
  • Canagliflozin and empagliflozin have label indication for reducing major adverse CV events.9,12

  • Canagliflozin, dapagliflozin and empagliflozin have shown reduction in hospitalisation for heart failure and to reduce chronic kidney disease progression in CV trials9,11,12

    • canagliflozin and dapagliflozin have primary renal outcome data9,15

    • canagliflozin is now licenced for the treatment of diabetic kidney disease in T2D9

    • dapagliflozin and empagliflozin have primary heart failure outcome data16,17

    • dapagliflozin is now licenced for the treatment of heart failure with reduced ejection fraction in people with or without T2D.11 When used in people with GFR <45, the effect on glucose lowering is likely to be minimal or absent but the medication is still indicated for people with heart failure with reduced ejection fraction.

Further trial results in areas of chronic kidney disease and heart failure are coming which may impact licensed indications in future. Please refer to current SmPC for individual drug for latest information on licenced indications and dose adjustment recommendations.
  • CV = cardiovascular; eGFR = estimated glomerular filtration rate (mL/min/1.73 m2); HbA1c = glycated haemoglobin; HFrEF = heart failure with reduced ejection fraction; SGLT2 = sodium glucose co-transporter 2; SmPC = summary of product characteristics; T2D = type 2 diabetes. Box colours: green = initiate; yellow = can initiate in certain circumstances; orange = do not initiate but can continue established treatment; red = treatment not recommended.