Bexagliflozin
BRENZAVVY
Pronunciation: bex-a-gli-FLOE-zin (bren-ZA-vee)
“Beck's a' Brewin' gravy”
SGLT2 inhibitor theme
What it isSGLT2 inhibitor causing urinary glucose and sodium loss; type 2 diabetes.
Why this oneIts practical distinction is lower acquisition cost rather than proven cardiorenal superiority.
What limits itUnlike established gliflozins, it lacks cardiovascular and renal outcome evidence; genital infection and euglycemic ketoacidosis remain.
FDA-approved for
- type 2 diabetes (2023)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 2 diabetes mellitus (glycemic control adjunct) | Adults | 20 mg QD | 20 mg QD | 20 mg QD |
Renal Not recommended if eGFR < 30 mL/min/1.73 m2; assess renal function before initiation
Hepatic Not recommended in severe hepatic impairment
Instructions
- Take once daily in the morning, with or without food
- Do not crush or chew
- Correct volume depletion before initiating
- Withhold at least 3 days before surgery/prolonged fasting; resume when clinically stable
Available strengths
- tab 20 mg
Cautions
- Diabetic ketoacidosis (may occur with normal glucose) — assess and discontinue if suspected
- Lower-limb amputation risk — monitor feet
- Volume depletion / acute kidney injury
- Genitourinary infections including urosepsis, pyelonephritis, Fournier's gangrene, genital mycotic infections
- Hypoglycemia with insulin/secretagogues — consider lowering their dose
Adverse reactions
- Female genital mycotic infections
- Urinary tract infection
- Increased urination
Pregnancy Not recommended in 2nd and 3rd trimesters (animal renal effects); data insufficient in 1st
Lactation Not recommended while breastfeeding
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 20 mg | tab | 30 qd | offered |
Generic entry2037 est.
NO BOXED WARNINGS
Principal riskIt lacks the outcome data the other gliflozins carry
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.
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