ce CONTINUING EDUCATION on urinary glucose excretion and increased urina- tion frequency. Bexagliflozin can also cause acute kidney injury due to volume depletion, so a patient’s renal function should be assessed prior to initiation. Bexagliflozin is not indicated for glycemic control in patients with type I DM due to the increased risk of diabetic ketoacidosis (DKA).
Consider ketone monitoring in patients at risk for DKA and assess for ketoacidosis regardless of pre- senting blood glucose levels. Bexagliflozin should be discontinued if DKA is suspected. It is contrain- dicated in patients undergoing hemodialysis, and is not recommended if eGFR is less than 30 mL/min. Bexagliflozin increases the risk of lower limb ampu- tation; patients should be monitored closely for signs of infection or ulcers in the lower limbs. In 2008, the FDA published guidance for manu- facturers seeking approval of SGLT2 inhibitors to establish acceptable risks for major cardiovascu- lar adverse events (MACE). It is important to note that bexagliflozin did not increase the risk of MACE in patients with type II DM versus placebo or active control. 15 How Supplied: Bexagliflozin is available as a 20 mg tablet in bottle counts of 30 and 90. The bottles should be stored at controlled room temperature and protected from high humidity and moisture. Bexagliflozin is a more affordable option than other SGLT2 inhibitors on the market and is a good option for patients who are self-pay or who have high deductibles. It is available through online pharmacy partners without prescription insurance. The patient can set up an account with the online pharmacy and it will be shipped directly to the patient without a prior authorization. All that is needed is the patient’s email address and an elec- tronic prescription. Additional Notes: Counsel patients to follow routine standards of care to prevent diabetes asso- ciated complications such as maintaining a healthy diet, getting regular physical activity, receiving reg- ular foot and eye exams, and self-monitoring blood glucose.
include metformin, sulfonylureas, insulin, dipeptidyl peptidase 4 (DPP-4) inhibitors, or combinations of these agents). 14 Bexagliflozin is a selective inhibitor of the sodi- um-glucose co-transporter 2 (SGLT2), which is the transporter responsible for reabsorption of most of the glucose from the renal glomerular filtrate in the renal proximal tubule. By inhibiting SGLT2, bexagli- flozin reduces renal reabsorption of filtered glucose and lowers the renal threshold for glucose, thereby increasing urinary glucose excretion. It is the fifth 5 SGLT-2 to be approved and is the first SGLT2 inhib- itor shown to be effective in adults with type II DM and stage 3 chronic kidney disease (CKD). Administration: The dose of bexagliflozin is 20 mg taken orally every morning with or without food. Counsel patients to swallow the tablet whole, do not crush, split or chew. If a dose is missed, it should be taken as soon as possible that same day. Do not take more than one dose at a time. Bexagliflozin should be withheld for at least 3 days if surgery or a procedure required prolonged fasting is required. Safety: Like other SGLT2 inhibitors, the most common adverse reactions associated with bexagli- flozin are female mycotic infections, urinary tract infections, and increased urination due to the effects
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