Segluromet

Last updated on RxList: 2/6/2020
Segluromet Side Effects Center

What Is Segluromet?

Segluromet (ertugliflozin and metformin hydrochloride) is a combination of a sodium glucose co-transporter 2 (SGLT2) inhibitor and a biguanide indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are not adequately controlled on a regimen containing ertugliflozin or metformin, or in patients who are already treated with both ertugliflozin and metformin.

What Are Side Effects of Segluromet?

Common side effects of Segluromet include:

Dosage for Segluromet

The starting dose of Segluromet is individualized based on the patient's current regimen. The maximum recommended dose is 7.5 mg ertugliflozin/1,000 mg metformin twice daily. Segluromet may interact with:

  • topiramate or other carbonic anhydrase inhibitors,
  • ranolazine,
  • vandetanib,
  • dolutegravir,
  • cimetidine,
  • alcohol,
  • thiazides and other diuretics,
  • corticosteroids,
  • phenothiazines,
  • thyroid products,
  • estrogens,
  • oral contraceptives,
  • phenytoin,
  • nicotinic acid,
  • sympathomimetics,
  • calcium channel blockers,
  • and isoniazid.

What Drugs, Substances, or Supplements Interact with Segluromet?

Segluromet During Pregnancy and Breastfeeding

Tell your doctor all medications and supplements you use. Segluromet is not recommended for use during pregnancy; it may harm a fetus. It is unknown if Segluromet passes into breast milk. Because of the potential for serious adverse reactions in a breastfed infant, breastfeeding while using Segluromet is not recommended.

Additional Information

Our Segluromet (ertugliflozin and metformin hydrochloride) Tablets, for Oral Use Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

SLIDESHOW

Type 2 Diabetes: Signs, Symptoms, Treatments See Slideshow
Segluromet Consumer Information

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Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Seek medical attention right away if you have signs of a genital infection (penis or vagina): burning, itching, odor, discharge, pain, tenderness, redness or swelling of the genital or rectal area, fever, not feeling well. These symptoms may get worse quickly.

Call your doctor at once if you have:

  • new pain, tenderness, sores, ulcers, or infections in your legs or feet;
  • little or no urination;
  • lactic acidosis--unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired;
  • ketoacidosis (too much acid in the blood)--nausea, vomiting, stomach pain, confusion, unusual drowsiness, or trouble breathing;
  • dehydration symptoms--dizziness, weakness, feeling light-headed (like you might pass out); or
  • signs of a bladder infection--pain or burning when you urinate, increased urination, blood in your urine, fever, pain in your pelvis or back.

Some side effects may be more likely to occur in older adults.

Common side effects may include:

  • genital yeast infection;
  • stomach discomfort;
  • nausea, vomiting, diarrhea, gas;
  • headache, weakness; or
  • urinating more than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Segluromet (Ertugliflozin and Metformin Hydrochloride Tablets)

QUESTION

______________ is another term for type 2 diabetes. See Answer
Segluromet Professional Information

SIDE EFFECTS

The following important adverse reactions are described elsewhere in the labeling:

  • Lactic Acidosis [see BOX WARNING and WARNINGS AND PRECAUTIONS]
  • Hypotension [see WARNINGS AND PRECAUTIONS]
  • Ketoacidosis [see WARNINGS AND PRECAUTIONS]
  • Acute Kidney Injury and Impairment in Renal Function [see WARNINGS AND PRECAUTIONS]
  • Urosepsis and Pyelonephritis [see WARNINGS AND PRECAUTIONS]
  • Lower Limb Amputation [see WARNINGS AND PRECAUTIONS]
  • Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues [see WARNINGS AND PRECAUTIONS]
  • Necrotizing Fasciitis of the Perineum (Fournier’s gangrene) [see WARNINGS AND PRECAUTIONS]
  • Genital Mycotic Infections [see WARNINGS AND PRECAUTIONS]
  • Vitamin B12 Levels [see WARNINGS AND PRECAUTIONS]
  • Increases in Low-Density Lipoprotein Cholesterol (LDL-C) [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Ertugliflozin And Metformin Hydrochloride

The incidence and type of adverse reactions in the two 26-week, placebo-controlled trials of ertugliflozin 5 mg and 15 mg added to metformin, representing a majority of data from the three 26-week, placebo-controlled trials, were similar to the adverse reactions described in Table 1.

Ertugliflozin

Pool of Placebo-Controlled Trials

The data in Table 1 are derived from a pool of three 26-week, placebo-controlled trials. Ertugliflozin was used as monotherapy in one trial and as add-on therapy in two trials [see Clinical Studies]. These data reflect exposure of 1,029 patients to ertugliflozin with a mean exposure duration of approximately 25 weeks. Patients received ertugliflozin 5 mg (N=519), ertugliflozin 15 mg (N=510), or placebo (N=515) once daily. The mean age of the population was 57 years and 2% were older than 75 years of age. Fifty-three percent (53%) of the population was male and 73% were Caucasian, 15% were Asian, and 7% were Black or African American. At baseline the population had diabetes for an average of 7.5 years, had a mean HbA1c of 8.1%, and 19.4% had established microvascular complications of diabetes. Baseline renal function (mean eGFR 88.9 mL/min/1.73 m2) was normal or mildly impaired in 97% of patients and moderately impaired in 3% of patients.

Table 1 shows common adverse reactions associated with the use of ertugliflozin. These adverse reactions were not present at baseline, occurred more commonly on ertugliflozin than on placebo, and occurred in at least 2% of patients treated with either ertugliflozin 5 mg or ertugliflozin 15 mg.

Table 1: Adverse Reactions Reported in ≥2% of Patients with Type 2 Diabetes MellitusTreated with Ertugliflozin* and Greater than Placebo in Pooled Placebo-Controlled Clinical Studiesof Ertugliflozin Monotherapy or Combination Therapy

Number (%) of Patients
Placebo
N = 515
Ertugliflozin 5 mg
N = 519
Ertugliflozin 15 mg
N = 510
Female genital mycotic infections3.0%9.1%12.2%
Male genital mycotic infections0.4%3.7%4.2%
Urinary tract infections§3.9%4.0%4.1%
Headache2.3%3.5%2.9%
Vaginal pruritus0.4%2.8%2.4%
Increased urination#1.0%2.7%2.4%
Nasopharyngitis2.3%2.5%2.0%
Back pain2.3%1.7%2.5%
Weight decreased1.0%1.2%2.4%
ThirstÞ0.6%2.7%1.4%
* The three placebo controlled studies included one monotherapy trial and two add-on combination trials with metformin or with metformin and sitagliptin.
Includes: genital candidiasis, genital infection fungal, vaginal infection, vulvitis, vulvovaginal candidiasis, vulvovaginal mycotic infection, and vulvovaginitis. Percentages calculated with the number of female patients in each group as denominator: placebo (N=235), ertugliflozin 5 mg (N=252), ertugliflozin 15 mg (N=245).
Includes: balanitis candida, balanoposthitis, genital infection, and genital infection fungal. Percentages calculated with the number of male patients in each group as denominator: placebo (N=280), ertugliflozin 5 mg (N=267), ertugliflozin 15 mg (N=265).
§ Includes: cystitis, dysuria, streptococcal urinary tract infection, urethritis, urinary tract infection.
Includes: vulvovaginal pruritus and pruritus genital. Percentages calculated with the number of female patients in each group as denominator: placebo (N=235), ertugliflozin 5 mg (N=252), ertugliflozin 15 mg (N=245).
# Includes: pollakiuria, micturition urgency, polyuria, urine output increased, and nocturia.
Þ Includes: thirst, dry mouth, polydipsia, and dry throat.

Volume Depletion

Ertugliflozin causes an osmotic diuresis, which may lead to intravascular volume contraction and adverse reactions related to volume depletion, particularly in patients with impaired renal function (eGFR less than 60 mL/min/1.73 m2). In patients with moderate renal impairment, adverse reactions related to volume depletion (e.g., dehydration, dizziness postural, presyncope, syncope, hypotension, and orthostatic hypotension) were reported in 0%, 4.4%, and 1.9% of patients treated with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively. Ertugliflozin may also increase the risk of hypotension in other patients at risk for volume contraction [see Use In Specific Populations].

Ketoacidosis

Across the clinical program, ketoacidosis was identified in 3 of 3,409 (0.1%) ertugliflozin-treated patients and 0.0% of comparator-treated patients [see WARNINGS AND PRECAUTIONS].

Impairment in Renal Function

Treatment with ertugliflozin was associated with increases in serum creatinine and decreases in eGFR (see Table 2). Patients with moderate renal impairment at baseline had larger mean changes. In a study in patients with moderate renal impairment, these abnormal laboratory findings were observed to reverse after treatment discontinuation [see Use In Specific Populations].

Table 2: Changes from Baseline in Serum Creatinine and eGFR in the Pool of Three 26-Week Placebo-Controlled Studies and a 26-Week Moderate Renal Impairment Study in Patients with Type 2 Diabetes Mellitus

Pool of 26-Week Placebo-Controlled Studies
Placebo
N = 515
Ertugliflozin 5 mg
N = 519
Ertugliflozin 15 mg
N = 510
Baseline MeanCreatinine (mg/dL)0.830.820.82
eGFR (mL/min/1.73 m2)89.588.289.0
Week 6 ChangeCreatinine (mg/dL)0.000.030.03
eGFR (mL/min/1.73 m2)-0.3-2.7-3.1
Week 26 ChangeCreatinine (mg/dL)-0.010.000.01
eGFR (mL/min/1.73 m2)0.70.5-0.6
Moderate Renal Impairment Study
Placebo
N = 154
Ertugliflozin 5 mg
N = 154
Ertugliflozin 15 mg
N = 154
BaselineCreatinine (mg/dL)1.391.381.37
eGFR (mL/min/1.73 m2)46.046.846.9
Week 6 ChangeCreatinine (mg/dL)-0.020.110.12
eGFR (mL/min/1.73 m2)0.6-3.2-4.1
Week 26 ChangeCreatinine (mg/dL)0.020.080.10
eGFR (mL/min/1.73 m2)0.0-2.7-2.6
.

Renal-related adverse reactions (e.g., acute kidney injury, renal impairment, acute prerenal failure) may occur in patients treated with ertugliflozin, particularly in patients with moderate renal impairment where the incidence of renal-related adverse reactions was 0.6%, 2.5%, and 1.3% in patients treated with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively.

Lower Limb Amputation

Across seven Phase 3 clinical trials in which ertugliflozin was studied as monotherapy and in combination with other antihyperglycemic agents, non-traumatic lower limb amputations occurred in 1 of 1,450 (0.1%) in the non-ertugliflozin group, 3 of 1,716 (0.2%) in the ertugliflozin 5 mg group, and 8 of 1,693 (0.5%) in the ertugliflozin 15 mg group.

Hypoglycemia

The incidence of hypoglycemia by study is shown in Table 3.

Table 3: Incidence of Overall* and Severe Hypoglycemia in Placebo-Controlled Clinical Studies inPatients with Type 2 Diabetes Mellitus

Add-on Combination Therapywith Metformin (26 weeks)Placebo
(N = 209)
Ertugliflozin5 mg
(N = 207)
Ertugliflozin15 mg
(N = 205)
Overall [N (%)]9 (4.3)15 (7.2)16 (7.8)
Severe [N (%)]1 (0.5)1 (0.5)0 (0.0)
Add-on Combination Therapywith Metformin and Sitagliptin(26 weeks)Placebo
(N = 153)
Ertugliflozin5 mg
(N = 156)
Ertugliflozin15 mg
(N = 153)
Overall [N (%)]5 (3.3)7 (4.5)3 (2.0)
Severe [N (%)]1 (0.7)1 (0.6)0 (0.0)
* Overall hypoglycemic events: plasma or capillary glucose of less than or equal to 70 mg/dL.
Severe hypoglycemic events: required assistance, lost consciousness, or experienced a seizure regardless of blood glucose.

Genital Mycotic Infections

In the pool of three placebo-controlled clinical trials, the incidence of female genital mycotic infections (e.g., genital candidiasis, genital infection fungal, vaginal infection, vulvitis, vulvovaginal candidiasis, vulvovaginal mycotic infection, vulvovaginitis) occurred in 3%, 9.1%, and 12.2%, of females treated with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively (see Table 1). In females, discontinuation due to genital mycotic infections occurred in 0% and 0.6% of patients treated with placebo and ertugliflozin, respectively.

In the same pool, male genital mycotic infections (e.g., balanitis candida, balanoposthitis, genital infection, genital infection fungal) occurred in 0.4%, 3.7%, and 4.2% of males treated with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively. Male genital mycotic infections occurred more commonly in uncircumcised males. In males, discontinuations due to genital mycotic infections occurred in 0% and 0.2% of patients treated with placebo and ertugliflozin, respectively. Phimosis was reported in 8 of 1,729 (0.5%) male ertugliflozin-treated patients, of which four required circumcision.

Metformin

The most common (5% or greater incidence) established adverse reactions due to initiation of metformin therapy are diarrhea, nausea, vomiting, flatulence, abdominal discomfort, indigestion, asthenia, and headache.

Long-term treatment with metformin has been associated with a decrease in vitamin B12 absorption, which may very rarely result in clinically significant vitamin B12 deficiency (e.g., megaloblastic anemia).

Laboratory Tests

Ertugliflozin

Increases in Low-Density Lipoprotein Cholesterol (LDL-C)

In the pool of three placebo-controlled trials, dose-related increases in LDL-C were observed in patients treated with ertugliflozin. Mean percent changes from baseline to Week 26 in LDL-C relative to placebo were 2.6% and 5.4% with ertugliflozin 5 mg and ertugliflozin 15 mg, respectively. The range of mean baseline LDL-C was 96.6 to 97.7 mg/dL across treatment groups [see WARNINGS AND PRECAUTIONS].

Increases in Hemoglobin

In the pool of three placebo-controlled trials, mean changes (percent changes) from baseline to Week 26 in hemoglobin were -0.21 g/dL (-1.4%) with placebo, 0.46 g/dL (3.5%) with ertugliflozin 5 mg, and 0.48 g/dL (3.5%) with ertugliflozin 15 mg. The range of mean baseline hemoglobin was 13.90 to 14.00 g/dL across treatment groups. At the end of treatment, 0.0%, 0.2%, and 0.4% of patients treated with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively, had a hemoglobin increase greater than 2 g/dL and above the upper limit of normal.

Increases in Serum Phosphate

In the pool of three placebo-controlled trials, mean changes (percent changes) from baseline in serum phosphate were 0.04 mg/dL (1.9%) with placebo, 0.21 mg/dL (6.8%) with ertugliflozin 5 mg, and 0.26 mg/dL (8.5%) with ertugliflozin 15 mg. The range of mean baseline serum phosphate was 3.53 to 3.54 mg/dL across treatment groups. In a clinical trial of patients with moderate renal impairment, mean changes (mean percent changes) from baseline at Week 26 in serum phosphate were -0.01 mg/dL (0.8%) with placebo, 0.29 mg/dL (9.7%) with ertugliflozin 5 mg, and 0.24 mg/dL (7.8%) with ertugliflozin 15 mg.

Metformin

In controlled clinical trials of metformin of 29 weeks duration, a decrease to subnormal levels of previously normal serum vitamin B12 levels, without clinical manifestations, was observed in approximately 7% of patients. Such decreases, possibly due to interference with B12 absorption from the B12-intrinsic factor complex is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or vitamin B12 supplementation [see WARNINGS AND PRECAUTIONS].

Postmarketing Experience

Additional adverse reactions have been identified during postapproval use. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

  • Cases of necrotizing fasciitis of the perineum (Fournier’s gangrene) have been seen with SGLT2 inhibitors [see WARNINGS AND PRECAUTIONS]

Read the entire FDA prescribing information for Segluromet (Ertugliflozin and Metformin Hydrochloride Tablets)

© Segluromet Patient Information is supplied by Cerner Multum, Inc. and Segluromet Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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