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Segluromet
ertugliflozin/ metformin
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle with nonspecific symptoms including malaise, myalgias, respiratory distress, somnolence, abdominal pain; lab findings include lactate >5 mmol/L, anion gap acidosis (without evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may include renal impairment, concomitant meds, patients 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immediately if lactic acidosis suspected, hospitalize patient and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: TAB: 2.5 mg/500 mg, 2.5 mg/1000 mg, 7.5 mg/500 mg, 7.5 mg/1000 mg
diabetes mellitus, type 2
- [conversion from metformin]
- Dose: 1 tab PO bid; Start: ertugliflozin 2.5 mg PO bid plus current daily metformin dose PO divided bid; Max: 15 mg/2000 mg/day; Info: give with meals; hold tx at least 4 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from ertugliflozin]
- Dose: 1 tab PO bid; Start: current daily ertugliflozin dose PO divided bid plus metformin 500 mg PO bid; Max: 15 mg/2000 mg/day; Info: give with meals; hold tx at least 4 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from ertugliflozin plus metformin]
- Dose: 1 tab PO bid; Start: equivalent total daily dose of each component in current regimen PO divided bid; Max: 15 mg/2000 mg/day; Info: give with meals; hold tx at least 4 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
renal dosing
- [see below]
- eGFR 30-44: avoid use; eGFR <30: contraindicated
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.