SGLT2 inhibitors
Tablets that make the kidneys flush extra sugar out in the urine. They started as diabetes medicines, then turned out to protect the heart and kidneys, even in people without diabetes. The rare medicine that over-delivered.
At a glance
- For
- Type 2 diabetes; heart failure; chronic kidney disease (with or without diabetes)
- Works
- Heart failure: about a fifth to a quarter fewer hospital stays for heart failure or heart deaths. Kidney disease: risk of kidney decline or death cut by about 30–40% in big trials. Diabetes: a modest drop in blood sugar, often with a little weight loss
- Cost
- Dapagliflozin and empagliflozin: on the PBS for type 2 diabetes, heart failure and chronic kidney disease (criteria apply). Ertugliflozin: PBS for type 2 diabetes
- Kicks in
- Blood sugar falls within days; heart and kidney protection builds over months to years
- Taken for
- Long term
- Watch for
- Genital thrush, passing more urine, dizziness on standing, urine infections; rarely ketoacidosis
Weeing out sugar sounds like a cheat code. The fine print: keep things clean down there, and pause it on sick days.
Brand names
- Empagliflozin: Jardiance; with metformin (Jardiamet) or linagliptin
- Dapagliflozin: Forxiga; with metformin (Xigduo XR) or saxagliptin
- Ertugliflozin: Steglatro; also in combinations
- Canagliflozin: Invokana (used overseas; removed from the PBS in 2015)
How it works
SGLT2 is a pump in the kidney that pulls sugar back into the blood. Blocking it lets extra sugar, plus some salt and water, leave in the urine. That lowers blood sugar, eases the fluid load on the heart and lowers the pressure inside the kidney’s filters.
Used for
- Type 2 diabetes, alongside diet and exercise (all four)
- Heart failure, whether the heart pump is weak or stiff, with or without diabetes (empagliflozin, dapagliflozin)
- Chronic kidney disease, with or without diabetes (empagliflozin, dapagliflozin)
- Not approved for type 1 diabetes in Australia
Compared
Same family, one tablet a day each. The difference is which big trials they have behind them, and so what they’re approved for. Trial results are “bad outcome” rates on the medicine versus a dummy treatment.
- Heart, kidney and diabetesEmpagliflozin (Jardiance)
- Approved for
- Type 2 diabetes, heart failure, chronic kidney disease
- Dose
- 10 mg once a day (up to 25 mg for diabetes)
- Big trials
- EMPA-REG OUTCOME (diabetes plus heart disease, 3 years): heart deaths 3.7% vs 5.9%; heart failure hospital stays 2.7% vs 4.1%. EMPEROR-Reduced (weak heart pump, 16 months): heart death or heart failure hospital stay 19.4% vs 24.7%. EMPEROR-Preserved (stiff heart, about 2 years): 13.8% vs 17.1%. EMPA-KIDNEY (kidney disease, 2 years): kidney decline or heart death 13.1% vs 16.9%
- PBS
- Yes, for all three uses (criteria apply)
- Heart, kidney and diabetesDapagliflozin (Forxiga)
- Approved for
- Type 2 diabetes, heart failure, chronic kidney disease
- Dose
- 10 mg once a day
- Big trials
- DAPA-HF (weak heart pump, 18 months): worsening heart failure or heart death 16.3% vs 21.2%. DELIVER (stiffer heart, 2.3 years): 16.4% vs 19.5%. DAPA-CKD (kidney disease, 2.4 years): kidney decline or kidney or heart death 9.2% vs 14.5%, with or without diabetes
- PBS
- Yes, for all three uses; heart failure with a stiff heart added in May 2026 (criteria apply)
- Diabetes onlyErtugliflozin (Steglatro)
- Approved for
- Type 2 diabetes
- Dose
- 5 mg once a day (up to 15 mg)
- Big trials
- VERTIS CV (diabetes plus heart disease, 3.5 years): heart attacks, strokes and heart deaths no different (11.9% in both groups), so safe for the heart but no extra protection. Fewer heart failure hospital stays (about 0.7 vs 1.1 per 100 people a year)
- PBS
- Yes, for type 2 diabetes
- OverseasCanagliflozin (Invokana)
- Approved for
- Type 2 diabetes; in some countries (such as the US) also to protect the kidneys in diabetes-related kidney disease
- Dose
- 100 mg once a day (up to 300 mg)
- Big trials
- CREDENCE (diabetes plus kidney disease, 2.6 years): kidney failure, kidney decline or kidney or heart death about 4.3 vs 6.1 per 100 people a year. No extra amputations or fractures in that trial
- PBS
- No; removed from the PBS in 2015
Side effects
Most people have no trouble. The usual ones: genital thrush (vaginal thrush or an itchy, sore penis tip), passing more urine, thirst and feeling light-headed on standing, especially in older people or with fluid tablets.
Full side-effect list (from the product information)
How often, from the empagliflozin product information and its big trials. Others in the family are similar. Bold = serious.
Common 1 in 10 to 1 in 100
- Genital thrush (about 4 in 100; up to about 1 in 10 women in the long heart trial)
- Urine infections, mainly in women
- Passing more urine, including at night
- Low blood sugar, mainly with insulin or a sulfonylurea
- Dehydration and dizziness on standing in people 75 and over
Uncommon 1 in 100 to 1 in 1,000
- Dehydration or low blood pressure (younger people)
- Kidney infection or urine infection spreading to the blood
- Ketoacidosis, which can happen with a normal blood sugar
Frequency not known reported, rate unclear
- Fournier’s gangrene: a very rare, serious infection of the skin around the genitals and back passage
Get help urgently if
- Nausea, vomiting, tummy pain, unusual tiredness or fast, deep breathing, even if your blood sugar is normal (possible ketoacidosis)
- Pain, tenderness, redness or swelling around the genitals or back passage, with fever or feeling unwell
- Fever, back pain or feeling very unwell with a urine infection
- Fainting or severe dizziness from dehydration
Good to know
- Sick day rules. Pause it if you’re vomiting, have diarrhoea or a fever, or can’t eat and drink normally. Restart once you’ve been eating and drinking normally for 24 to 48 hours.
- Surgery and procedures. Usually stopped for at least 3 days (2 days before, plus the day) for surgery needing a hospital stay or a colonoscopy with bowel prep; just on the day for a short day procedure like a gastroscopy. Your team will confirm.
- Fasting, crash diets and being dehydrated raise the ketoacidosis risk.
- Keep the genital area clean and dry. Tell your doctor about itching or discharge.
- Not used in pregnancy or breastfeeding.
Common questions
Why take a diabetes tablet if I don’t have diabetes?
Dapagliflozin and empagliflozin protect the heart and kidneys whether or not you have diabetes. In big trials of heart failure and kidney disease, people without diabetes benefited too.
What are SGLT2 sick day rules?
Pause the tablet if you’re vomiting, have diarrhoea or a fever, or can’t eat and drink normally. Restart once you’ve been eating and drinking normally for 24 to 48 hours. This lowers the risk of dehydration and ketoacidosis.
Why do SGLT2 inhibitors cause thrush?
They put extra sugar in the urine, which feeds yeast in the genital area. Washing daily and keeping the area dry helps. See your doctor about itching or discharge.
Do I need to stop my SGLT2 inhibitor before surgery?
Usually yes. For surgery needing a hospital stay or a colonoscopy, it’s usually stopped 2 days before and on the day. For a short day procedure, often just on the day. Your surgical team will confirm.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- EMPA-REG OUTCOME trial summary (American College of Cardiology)
- DAPA-HF trial: Dapagliflozin in heart failure (NEJM)
- EMPEROR-Reduced trial (NEJM)
- EMPEROR-Preserved trial results (Healio)
- DELIVER trial summary (American College of Cardiology)
- DAPA-CKD trial: Dapagliflozin in kidney disease (NEJM)
- EMPA-KIDNEY trial (NEJM)
- CREDENCE trial: Canagliflozin in diabetic kidney disease (NEJM)
- VERTIS CV trial summary (American College of Cardiology)
- Australian Diabetes Society: SGLT2 inhibitors and ketoacidosis around procedures (2022)
- newsGP: Jardiance PBS listing expanded for kidney disease
- The Limbic: Dapagliflozin PBS listing for heart failure with preserved ejection fraction (May 2026)
- Healthdirect: Medicines information
maladywise.com/medicines/sglt2-inhibitors/