On May 15, 2015, the FDA issued a warning for the newest class of diabetes medications, SGLT2 inhibitors.
According to the FDA, the medications in this class may lead to a serious and life-threatening condition known as ketoacidosis.
Which medications are considered SGLT2 inhibitors?
These medications also contain SGLT2 inhibitors in combination with other active ingredients:
- Glyxambi (empagliflozin/linagliptin)
- Invokamet (canagliflozin/metformin)
- Xigduo XR (dapagliflozin/metformin)
What should I do if I am taking one of these medications?
If you are taking one of the medications listed above DO NOT stop your medication without talking to your doctor.
Monitor yourself for the signs and symptoms associated with ketoacidosis and if needed, seek emergency medical attention.
What are the benefits of SGLT2 inhibitors?
Not only have SGLT2 inhibitors been shown to lower blood glucose levels, but they can also help with weight loss, a reduction of A1C levels, and to lower blood pressure–all of which can be concerns for diabetics.
What is ketoacidosis?
Ketoacidosis is a condition where there is too much acid in the blood, which can basically poison the body. These blood acids are better known as ketones.
What are the common signs and symptoms of ketoacidosis?
The common signs and symptoms of ketoacidosis may include but are not limited to the following:
Early symptoms of ketoacidosis may include thirst, dry mouth, frequent urination, high blood sugar levels, and high ketone levels in the urine.
Some other common symptoms to watch out for are difficulty breathing, nausea and vomiting, stomach pain, confusion, fatigue, and sleepiness.
What are the typical side effects of SGLT2 inhibitors alone?
Common side effects of SGLT2 inhibitors include female genital infections & urinary tract infections.
How is ketoacidosis treated?
Treatment for ketoacidosis takes place in the hospital where you may be given fluids, electrolytes, and insulin.
How can I prevent ketoacidosis?
Ketoacidosis usually be prevented with proper diabetes management. For example:
- Make responsible decisions when it comes to your diabetes. Make sure you get proper nutrition and adequate exercise, and take your medications.
- Check your blood sugar at least 3 to 4 times per day, possibly more often if you are sick or stressed out.
- Check your urine for ketones using over-the-counter ketone test strips, especially if you’re feeling sick or stressed. Moderate to high ketone levels warrant a call to your doctor or an ER visit.
You can find more important info about the FDA warning here.
Medications these days are not only limited to traditional routes like taking a pill by mouth. A variety of new and improved dosage forms have been created with your best interests in mind.
If you have trouble remembering to take your medication, or for example, if you’re a diabetic who doesn’t like needles, one of the newer dosage forms just might be right for you!
What types of new dosage forms now exist?
- Iontophoretic transdermal systems
- Long-acting injections
- Inhaled medications
- Dissolvable tablets and films
Are there advantages to using these newer forms?
Yes—some of these new forms can help you resolve common issues like:
- Problems swallowing medication. Newer dissolvable tablets and films can help with swallowing problems. Some patients may have trouble swallowing larger tablets or capsules, and a dose that can be placed under the tongue or in the mouth to dissolve can be beneficial.
- Remembering to take your medication. New longer acting injections can help with medication recall. Once the injection is administered you may not need another dose of medication for 1 week to 6 months depending on the medication. Several long-acting injection options exist for indications such as birth control, mood stabilization, or osteoporosis.
- Fear of injecting your medication. New inhalational dosage forms can help with medication fear. An example of medication fear are those patients newly diagnosed with type 2 diabetes that have a fear of needles and injecting themselves with insulin. Recently, the FDA approved Afrezza, an inhaled insulin which may help reduce some of the nervousness associated with using insulin for newly diagnosed diabetics.
- Faster symptom improvement. New iontophoretic transdermal medication systems can help suffering patients with pain control in situations where fast relief is desired. Pain can be a result of many things for example surgery or a migraine. Recently approved iontophoretic topical medication systems produce a mild electrical current in order to deliver the medication through the skin.
- Ease of use. “Set it and forget it!” a common catch phrase used for crock pot dinners can actually be applied to the use of medications as well. Most patients would probably prefer a medication that they don’t really have to think about such as a topical patch or monthly injection. These dosage forms allow a patient to receive proper treatment with the least amount of effort.
Which medications are available through an iontophoretic transdermal system?
The iontophoretic delivery system actually uses a mild electrical current to deliver a medication through the skin. These drugs will be available as transdermal patches that offer a set dose of medication. There aren’t any currently available at your pharmacy, but some examples of how the system is used include:
- Pain management. Ionsys was approved by the FDA for pain management on May 7, 2015, but it is for use in hospitalized adults only.
- Migraine relief. Zecuity was approved by the FDA in January 2013, and is coming soon for acute migraine relief.
What sort of medications are available as long-acting injections?
Rather than a taking a daily pill or injection, you may be able to receive a long-acting injection weekly, monthly, or even less often. The following are examples of some types of medications that have this form available:
- Birth Control (Depo-Provera, medroxyprogesterone)
- Mood stabilizing drugs (Abilify Maintena, Risperdal Consta, Invega Sustenna)
- Osteoporosis (Prolia)
Which medications can be inhaled?
While you may be familiar with inhalers for asthma or COPD, you may not be aware that an inhaled insulin (Afrezza) recently became available for diabetes patients.
What sort of medications are available as dissolvable tablets or films?
Alternative forms like orally disintegrating tablets and sublingual films can be especially helpful if you have a difficult time swallowing. Even better news here—many of these are also available as as cheaper generics. Some medications that can be dissolved in your mouth or under your tongue include treatments for:
Dry mouth isn’t just an annoyance, it can lead to serious dental issues. Xerostomia is the medical term for dry mouth and when it happens, you’ll want to know what’s causing it.
Risk factors for dry mouth include medications, mouth breathing, older age, and a history of radiation therapy in cancer patients. Medical conditions that contribute to dry mouth include Sjögren’s syndrome, diabetes, and anxiety disorders, and these can be easily ruled out by your doctor.
Take a look at your medication list to see if your meds could be contributing to dry mouth. Here are the common players:
Anticholinergics. These are medications used for allergies, Parkinson’s, asthma, and overactive bladder.
- Urinary incontinence/overactive bladder meds: These are common causes of dry mouth—in fact, dry mouth is the number one reason folks stop taking these medications. Ditropan (oxybutynin) is a huge culprit of dry mouth in 29% to 71% of people taking it. Other meds used for overactive bladder that lead to dry mouth are are Enablex, Toviaz, Vesicare, Detrol LA (tolterodine ER), and Sanctura (trospium).
- Antihistamines used for allergies and asthma also cause dry mouth. Atarax and Vistaril (hydroxyzine hydrochloride), Clarinex (desloratadine), Xyzal (levocetirizine), Allegra (fexofenadine), Benadryl (diphenhydramine), Claritin (loratadine) and Zyrtec (cetirizine) can all leave you with a dry mouth.
- Parkinson’s meds like Cogentin (benztropine) can also cause dry mouth.
- Frequently used for the treatment of depression, selective serotonin reuptake inhibitors (SSRIs) often cause dry mouth. These include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft).
- Used for chronic pain management and for the treatment of depression, antidepressants such as amitriptyline, doxepin and clomipramine have a strong inhibiting influence on salivary secretion. This, in turn, may lead to dry mouth.
- ADHD medications like Adderall (amphetamine salt combo), Ritalin (methylphenidate) and Concerta (methylphenidate ER) can result in dry mouth in up to 35% of people taking them.
- Appetite suppressants like phentermine (Adipex-P) can also cause dry mouth.
- Anxiolytics (meds used for anxiety) like alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium) can cause dry mouth.
- Used for the treatment of high blood pressure, edema of the legs or heart failure, Lasix (furosemide) and hydrochlorothiazide (HCTZ) can also contribute to dry mouth.
The “typical” antipsychotics
- Used often in psychiatry: haloperidol (Haldol), chlorpromazine (Thorazine), and fluphenazine (Prolixin) are common culprits of dry mouth.
The “atypical” antipsychotics
- Dry mouth has been reported with the use of mood stabilizers like olanzapine (Zyprexa), risperidone (Risperdal), and clozapine (Clozaril).
Other mood stabilizers like lithium can also cause dry mouth.
Beta blockers, particularly propranolol, have been reported to cause dry mouth.
What can you do about it?
Frequent oral hygiene is the first step in treating dry mouth. Rinsing with cold water, Biotene mouthwash, sucking on ice chips, and chewing sugarless gum to increase salivation may provide comfort.
Temovate (clobetasol) and Temovate E (clobetasol emollient) are strong steroid creams indicated for the relief of inflammation and itching associated with certain skin disorders. They have the same active ingredient, but they are not the same medication. The main difference? Temovate E is an emollient cream.
When are steroid creams used?
What is an emollient?
An emollient is a preparation that softens or soothes the skin. Emollients help your skin feel more comfortable and less itchy.
Why use an emollient?
An emollient, unlike a steroid alone, can be used to prevent a flare-up from actually occurring.
Emollients prevent flare-ups by decreasing water loss from the skin and directly adding water to the dry outer layers of the skin. This protective film over the skin not only keeps moisture in, but also keeps out potential irritants.
What are the advantages of Temovate E cream?
The first advantage of using Temovate E over Temovate is the side effect profile. Temovate E combines the steroid medication with an emollient that helps hydrate and soothe your skin, which is important for skin disorders like eczema. Temovate E can cut down on the itchy, dry sensation that can come with these skin conditions.
The second advantage is cost-effectiveness. That hydration and soothing can also help reduce the need to use the steroid medication at all. That means you’ll most likely use Temovate E for a shorter duration compared to regular Temovate cream.
What are the disadvantages?
Although you may use less Temovate E, it may be more expensive—up to twice as much for the same size tube if you’re paying out of pocket. However, you should still be able to fine generic clobetasol emollient for under $20 with a discount for the smallest size 15 g tube of cream.
No. These medications are not considered the same and cannot be interchanged without getting the okay from your prescriber.
Want more information?
Follow these steps to help a burn heal and avoid making it worse:
- Cooling is the first step. Ideally you can find a cooled saline-soaked gauze but cooled or room temperature water is more practical; this is your starting point. A common mistake people make is putting ice on the burn, don’t do this.
- Gentle cleansing with mild soap and water are fine here. You could also use saline wound wash if you have it.
- Next step: do I need a topical antibiotic or not? You don’t always need to put Neosporin or Polysporin on your burn. Using a topical antibiotic is recommended, but not for minor burns (e.g. sunburns) and superficial burns with the skin intact. Those do not require a topical antimicrobial agent. For these burns, instead you will want to cover them with bismuth-impregnated petroleum based gauze (Xeroform) which you can buy over the counter.
- If you do need a topical antibiotic (if it’s more than just a sunburn or a superficial burn with the skin intact) silver sulfadiazine (Silvadene) is great, but requires a prescription. It is cheap and comes in a jar so keep this in your medicine chest for later. A good over the counter option for an uncomplicated burn is to use Polysporin ointment, then cover with a nonadherent (non-stick) dressing like Telfa pads.
- What about deeper burns? For deeper wounds or settings in which MRSA (methicillin-resistant Staph aureus) is of greater concern, think about using Bactroban (mupirocin) ointment—which is also a prescription med.
- What sort of bandages and dressings should I buy? Superficial burns don’t require any fancy dressing. A basic gauze will work. But again, a bismuth-impregnated petroleum based gauze (Xeroform) is comparable to the topical antibiotics for preventing or controling burn wound infection. Xeroform is applied as a single layer over the burn and then covered with a bulky dressing.
- How to do a basic dressing for burns (this goes for cuts too): A basic gauze dressing provides good burn coverage. It is placed after your topical antibiotic and consists of a first layer of nonadherent (non-stick) gauze like Adaptic or Telfa placed over the burn. Then you’ll want a second layer of fluffed dry gauze, and an outer layer of an elastic gauze roll (e.g. Kerlix).
- Use Tylenol or an NSAID (ibuprofen, Motrin, Aleve) for the pain.
Your shopping list to be ready for burns or cuts:
- Sterile saline wound wash
- Telfa pads
- Dry gauze pads
- Kerlix (elastic gauze roll)
- From your doctor: Silvadene cream and Bactroban ointment.