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HF was significantly lower (33%) with sotagliflozin than with placebo. 17 Administration: The initial dose of sotagliflozin is 200 mg by mouth once daily, no more than 1 hour before the first meal of the day. The dose can be titrated up to 400 mg once daily as tolerated over a 2-week period. The tablets should be swallowed whole; do not cut, crush, split, or chew. If a dose is missed, it should be taken as soon as possi- ble within 6 hours, otherwise, it should be skipped. Sotagliflozin should be held for 3 days prior to sur- gery or for a procedure requiring fasting. Fluid imbalances should be corrected prior to initiation and baseline renal function should be assessed. Safety: Like other SGLT-2 inhibitors, the most common side effects are urinary tract infections and genital mycotic infections. Hypotension due to fluid depletion is also a common side effect with sota- gliflozin, and diarrhea can occur due to its effects on intestinal absorption of glucose and sodium. Sotagliflozin is not approved for diabetes treatment due to concerns for DKA. 5 Use caution with con- comitant use of insulin or insulin-secretagogues (i.e., sulfonylureas) due to the risk of hypoglyce- mia; a decreased dose of insulin may be needed. Coadministration with UDP-glucuronosyltransferase (UGT) inducers may decrease the exposure to sota- gliflozin. Concomitant use with digoxin can increase digoxin levels and concomitant use with lithium can decrease lithium serum concentrations. How Supplied: Sotagliflozin is available as 200 mg and 400 mg film-coated tablets in bottle counts of 30 that should be stored at controlled room temperature. Tryvio (aprocitentan) 18 Indication and Mechanism of Action: Aprocitentan is a novel agent approved early in 2024 4 and will be available in the fall of 2024. It is the first and only dual endothelin receptor antagonist (ERA) approved to lower blood pressure in combi- nation with other antihypertensive drugs in adult
Inpefa (sotagliflozin) 16 Indication and Mechanism of Action: Sotagliflozin is approved to reduce the risk of cardiovascular (CV) death, hospitalization due to heart failure (HF), and urgent HF visits in adults with HF or adults with type II DM and CKD along with other CV risk factors. 17 It is an inhibitor of SGLT-2 and SGLT-1. Inhibiting SGLT2 reduces renal reabsorption of glucose and sodium which may influence several physiological functions such as lowering both pre-and afterload of the heart and downregulating sympathetic activ- ity. Inhibiting SGLT1 reduces intestinal absorption of glucose and sodium. However, the exact mechanism for sotagliflozin’s cardiovascular benefits has not been established. The 2022 American Heart Association/ American College of Cardiology/ Heart Failure Society of America (AHA/ACC/HFSA) Joint Guideline and the 2023 ACC consensus recommend SGLT inhibitors as first line treatment for HF with preserved ejec- tion fraction. This recommendation is based on the SOLOIST-WHF study which showed that among patients with type II DM who had worsening heart failure, the primary end point of the total number of CV deaths and hospitalizations and urgent visits for
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