Managing SGLT2 Inhibitor-Associated Genital Mycotic Infections

Strategies to prevent and manage sodium-glucose cotransporter 2 (SGLT2) inhibitor-associated genital mycotic infections were recently reviewed in a study published in the Annals of Pharmacotherapy.

Genital mycotic infection is listed as a potential adverse effect of the SGLT2 inhibitor class, which includes 4 Food and Drug Administration (FDA)-approved drugs: canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These agents are all indicated for the treatment of type 2 diabetes, with some having additional uses related to their cardiovascular and renal benefits.

To better understand the link between SGLT2 inhibitor use and genital mycotic infection, study authors conducted a literature search and identified articles that included data related to incidence, risk factors, prevention and management. While no date limit was set, articles published between 2010 and July 2020 were given priority.

“A 3- to 4-fold increase was seen across all clinical trials for each medication compared with placebo, and an even greater increase was observed when the data for female patients were analyzed,” the study authors reported. Moreover, patients with a history of recurrent genital mycotic infection were found to be at higher risk, while circumcised men were found have the lowest risk of infection.

According to the review, optimizing diabetes management and providing personal hygiene education (ie, rinse genital area with water after voiding and before bed; wear cotton underwear) may help reduce the chance of genital mycotic infection in patients taking SGLT2 inhibitors.  If infection does occur, management strategies may include the use of oral antifungals (ie, single dose of oral fluconazole) or topical antifungal creams (ie, miconazole or clotrimazole for 1-3 days), and in milder cases, over-the-counter topical antifungals.

“As more prescribers adopt the recommendations for the use of SGLT2 inhibitors described in the ADA Standards of Care, it is imperative that healthcare professionals are knowledgeable of the benefits and risks, strategies to enhance safety and efficacy, and management of SGLT2 inhibitor–related problems,” the study authors concluded. They added that “Strong consideration should be given to avoid SGLT2 inhibitors in female patients with a history of severe, recurrent infections.”

Reference

Engelhardt K, Ferguson M, Rosselli JL. Prevention and management of genital mycotic infections in the setting of sodium-glucose cotransporter 2 inhibitors [published online August 18, 2020 ]. Annals of Pharmacotherapy. doi.org/10.1177/1060028020951928.