New medical evidence indicates that lower limb amputations may be a “drug-class” side effect for all of the sodium-glucose cotransporter 2 (SGLT-2) inhibitor diabetes drugs which have been approved by the FDA to date.
We get the following explanation of this increased risk of toe, foot, or leg amputations for Jardiance and Farxiga as well as Invokana and other similar diabetes drugs from this October 2, 2018 Medscape Medical News report, “SGLT2 Inhibitor-Amputation Link in Diabetes — Is it Hypovolemia?”:
The mechanism behind the finding of an increased risk of lower-limb amputation in patients taking [Invokana (canagliflozin)] in the Canagliflozin Cardiovascular Assessment Study (CANVAS) has been much debated. Findings from observational trials of [Invokana (canagliflozin)] have conflicted regarding the amputation risk, and the effect hasn’t been seen with other SGLT2 inhibitors.
But, assuming the amputation risk is a class effect, one theory about the mechanism is that the reduction in plasma volume from SGLT2 inhibitors could lead to decreased perfusion, especially in patients who already have reduced lower limb perfusion. “If true, we hypothesized that diuretics would show a similar safety profile,” [explained Ronan Roussel, MD, PhD, chief of the endocrinology, diabetes, and nutrition department at Group Hôpital Bichat, AP-HP, Paris, France]….
“This is a strong signal,” he told Medscape Medical News in an interview, adding that the data suggest diuretics should be used with caution in patients who are at increased risk for amputation, such as those with critical ischemia.
As background, some diabetic patients at the highest risk of amputations are those with peripheral arterial disease or foot ulcers.
Given the increasing medical evidence that lower limb (leg, foot, toes) amputations are a drug-class side effect of SGLT-2 inhibitors, we continue to investigate amputation drug injury cases for patients using Invokana, Farxiga, Jardiance, and similar newer diabetes medications.[Read article in full at original source]
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