As reported in Pharmacy Times,
according to a new FDA warning 20 post marketing cases have been
cited. Some were ketosis without full blown ketoacidosis. Current
drugs in this new class are canagliflozin (Invokana), dapagliflozin
(Farxiga), and empagliflozin (Jardiance).
How might these drugs cause
ketoacidosis? No mechanism was cited in this report. I can
speculate on a few. Because they cause glycosuria, there are a
number of consequences that might tip a patient over who has marginal
insulin reserve (including patients thought to have type 2 diabetes
but who actually have some atypical form). First, glycosuria dumps
calories which could cause a catabolic state. In association with
this already marginal insulin levels might fall. If the glycosuria
results in volume depletion the neurohumoral response is counter
regulatory and antagonistic to insulin. Finally, the agents increase
the risk for urinary tract infections which might lead to
decompensation.
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