Introducing Steglatro – the newest Gliflozin soon to be PBS listed
By Donna Itzstein
Diabetes Queensland Pharmacist
Steglatro is the newest offering from pharmaceutical company
Merck Sharp & Dohme of Ertugliflozin for type 2 diabetes.
At the July meeting, the Pharmaceutical Benefits Advisory
Committee (PBAC) recommended the Authority Required (STREAMLINED)
listing of Ertugliflozin with Sitagliptin fixed dose products for
use in combination with metformin as triple oral therapy in
patients with type 2 diabetes.
The PBAC recommends PBS listing based on cost, safety and
efficacy being the same as Dapagliflozin or
Ertugliflozin blocks the sodium glucose cotransporter-2 (SGLT2)
in the proximal tubules of the kidney.
This action removes about 40 per cent of glucose, which would
have been reabsorbed. This is 70g of glucose per day, dragging
about 375ml water with it.
This estimate depends on renal function and carbohydrate
Expected actions include:
Brands, Strengths and dosing available in
Once daily in the morning
2.5/500mg, 2.5/1000 mg
Once daily in the morning
5 mg/100 mg & 15 mg/100 mg
Clinical information on SGLT2 inhibitors
- SGLT2 inhibitors are indicated for adult type 2 diabetes. They
are being administered off-label in type 1 diabetes to reduce
insulin requirements with the side benefit to cardiovascular risk.
Trials with promising results are underway in paediatric type 2
- Urinary tract infection and genital mycotic infection rates are
significantly increased with SGLT2 inhibitors and predominantly in
females. An increased but minute rate of genital gangrene is
observed with these agents. Volume depletion-related adverse events
due to the diuresis are reduced by adequate fluid
- Euglycaemic ketoacidosis occurs more frequently when the body
is under stress. Temporary withdrawal during illness or in low
carbohydrate diets is the best option. This frequency
increases when used in type 1 diabetes.
- Renal function is preserved long-term; however, acute renal
failure may happen upon initiation of SGLT2 inhibitors. Check renal
- Consider ceasing other diuretics to decrease the possibility of
hypovolaemia. Consider SGLT2 inhibitors carefully in elderly. These
agents increase the risk of fractures, falls.
- SGLT2 inhibitors increase the risk of hypoglycaemia when used
with insulin and sulfonylureas. Consider reducing the dose of these
Counselling tips for your patients
- SGLT2 inhibitors may improve cardiovascular risk.
- Euglycaemic acidosis is rare. Consider counselling to withdraw
when ill to be aware of symptoms.
- Remind patients on the value of foot care. There is a small but
increased possibility of amputation risk.
- The patient's urine contains glucose at all times while taking
- Urinary tract infections and genital infections (thrush) are
more likely. Maintain good hygiene and counsel on symptoms.
Encourage reporting symptoms immediately.
- Drink adequate water.
- If your patient is using these agents with insulin or a
sulfonylurea, counsel them on hypoglycaemia.
For more information on this article or general enquiries,
please contact us on 1300 136 588.