Meta Information
ID:ertugliflozin
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/antidiabetic-medications
Target name:
Insulin and Insulin Secretagogues (e.g., Sulfonylureas)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining ertugliflozin with medications that strongly increase insulin levels or sensitivity can lead to a severe drop in blood sugar (hypoglycemia).
Actionable advice:
Requires dose reduction of the insulin or secretagogue when starting ertugliflozin; monitor glucose closely.
Target id:
/class/loop-diuretics
Target name:
Loop Diuretics (e.g., Furosemide)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both ertugliflozin and loop diuretics cause fluid loss, and their combined use significantly increases the risk of dehydration, low blood pressure, and kidney injury.
Actionable advice:
Avoid combination if possible; if necessary, requires close monitoring of blood pressure, kidney function, and hydration status.
Target id:
/condition/renal-impairment
Target name:
Severe Renal Impairment (eGFR < 30)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin is not effective and may increase the risk of adverse events in patients with severely impaired kidney function (eGFR < 30 mL/min/1.73 m²).
Actionable advice:
Contraindicated in patients with an eGFR below 30; do not initiate therapy.
Target id:
/dietary/ketogenic-diet
Target name:
Ketogenic Diet
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining a ketogenic diet with ertugliflozin dramatically increases the risk of developing euglycemic diabetic ketoacidosis (DKA), a life-threatening condition where the blood becomes too acidic.
Actionable advice:
Avoid using ertugliflozin while on a ketogenic or very low-carbohydrate diet.
Target id:
/procedure/major-surgery
Target name:
Major Surgical Procedures
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
72
Hours after target:
null
Description:
The stress of surgery, fasting, and anesthesia increases the risk of dehydration and diabetic ketoacidosis (DKA). Ertugliflozin should be stopped beforehand.
Actionable advice:
Discontinue ertugliflozin at least 3 days prior to any major surgery or procedure.
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Taking ertugliflozin while already dehydrated can lead to severe volume depletion, low blood pressure, and acute kidney injury.
Actionable advice:
Ensure adequate fluid intake and correct any existing dehydration before starting or continuing this medication.
Target id:
/dietary/water
Target name:
Adequate Fluid Intake
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin works by increasing urination, so maintaining good hydration is essential to prevent side effects like dehydration, low blood pressure, and kidney problems.
Actionable advice:
Drink plenty of fluids throughout the day to stay well-hydrated while taking this medication.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin is not recommended during the second and third trimesters of pregnancy due to potential risks to fetal kidney development.
Actionable advice:
Avoid completely during pregnancy, especially in the second and third trimesters.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
It is not known if ertugliflozin passes into breast milk, but due to the potential for serious adverse reactions in the nursing infant, it is not recommended.
Actionable advice:
Avoid using while breastfeeding.
Target id:
/class/sglt2-inhibitors
Target name:
Other SGLT2 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Using more than one SGLT2 inhibitor provides no additional benefit and significantly increases the risk of all associated side effects, such as dehydration and ketoacidosis.
Actionable advice:
Never take ertugliflozin with another SGLT2 inhibitor like canagliflozin, dapagliflozin, or empagliflozin.
Target id:
/biomarker/1-5-ag-assay
Target name:
1,5-Anhydroglucitol (1,5-AG) Assay
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin increases glucose in the urine, which directly interferes with the 1,5-AG assay, making it an unreliable marker of glycemic control.
Actionable advice:
Do not use the 1,5-AG assay to monitor blood sugar control; use HbA1c or blood glucose monitoring instead.
Target id:
/biomarker/urine-glucose-test
Target name:
Urine Glucose Test
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
null
Description:
Due to its mechanism of action, ertugliflozin will cause a positive result on urine glucose tests, which does not reflect high blood sugar levels.
Actionable advice:
Do not use urine glucose tests to monitor blood sugar control; they will always be positive while on this medication.
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
NSAIDs can reduce kidney blood flow, and when combined with the dehydrating effect of ertugliflozin, the risk of acute kidney injury is significantly increased.
Actionable advice:
Avoid chronic use of NSAIDs; if used short-term, ensure adequate hydration and monitor kidney function.
Target id:
/class/ace-inhibitors
Target name:
ACE Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
This combination can increase the risk of low blood pressure, dehydration, and acute kidney injury, particularly in the elderly or those with pre-existing kidney issues.
Actionable advice:
Monitor blood pressure and kidney function regularly when using this combination, especially upon initiation.
Target id:
/class/arbs
Target name:
Angiotensin II Receptor Blockers (ARBs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
This combination can increase the risk of low blood pressure, dehydration, and acute kidney injury, particularly in the elderly or those with pre-existing kidney issues.
Actionable advice:
Monitor blood pressure and kidney function regularly when using this combination, especially upon initiation.
Target id:
/dietary/alcohol-acute
Target name:
Alcohol
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Alcohol can increase the risk of both low blood sugar (hypoglycemia) and diabetic ketoacidosis (DKA) when taken with ertugliflozin.
Actionable advice:
Limit alcohol consumption and avoid binge drinking while taking this medication.
Target id:
/class/antidiabetic-medications
Target name:
Other Diabetes Medications (e.g., Metformin, GLP-1s)
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin works well with other diabetes drugs that have different mechanisms, but the combination increases the overall risk of low blood sugar (hypoglycemia).
Actionable advice:
Monitor blood glucose levels closely when combining with other diabetes medications.
Target id:
/class/broad-spectrum-inducers
Target name:
Broad-Spectrum Metabolic Enzyme Inducers (e.g., Rifampin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Strong inducers of UGT enzymes (like rifampin) can accelerate the breakdown of ertugliflozin, potentially reducing its concentration and effectiveness in lowering blood sugar.
Actionable advice:
If co-administration is necessary, consider increasing the dose of ertugliflozin and monitor blood glucose closely.
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Older adults are more susceptible to the dehydrating effects of ertugliflozin, increasing their risk of falls, low blood pressure, and kidney problems.
Actionable advice:
Use with caution in older adults, ensuring adequate hydration and monitoring blood pressure and kidney function.
Target id:
/condition/history-of-gmi
Target name:
History of Genital Mycotic Infections
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Ertugliflozin increases glucose in the urine, which can promote the growth of yeast, leading to a higher incidence of genital mycotic infections (e.g., yeast infections).
Actionable advice:
Be aware of the increased risk and maintain good hygiene; seek treatment if symptoms occur.
Target id:
/condition/peripheral-vascular-disease
Target name:
Peripheral Vascular Disease or History of Amputation
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
An increased risk of lower limb amputations has been observed with another drug in this class (canagliflozin), so caution is warranted in high-risk individuals.
Actionable advice:
Regularly inspect feet for any new sores or infections and report them to your doctor immediately.
Target id:
/circadian/wake
Target name:
Morning / Waking Up
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
null
Hours after target:
1
Description:
Taking ertugliflozin in the morning helps to align its diuretic (increased urination) effect with daytime hours, reducing the chance of sleep disruption from nighttime urination (nocturia).
Actionable advice:
Take your dose in the morning, with or without food.