I don’t believe that is accurate, I think most of them can be split. The companies like to promote this idea so you won’t save money and will buy the lower dose/ higher price tablets, but I think they likely work just as well split. See this thread: Which pills can be split and in what dose and which cannot be split
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I have split dapa and monitored with a cgm. I did not see any issue.
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and I have split empagliflozin and monitored with CGM and all works as expected (greatly reduced blood glucose spikes).
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Is it possible for me to use this if I am on tirzepatide and berberine?
Another question: If these drugs cause you to pee out the sugar, would this mean you don’t feel the energy of the sugar that you’ve eaten? I ask this in the context of exercise, I consume carbohydrates before exercise. Would this blunt that energy?
Health data is very powerful. I had a similar experience. I unfortunately have sleep apnea, and shortly after getting my CPAP machine I drank some alcohol and that night had alarmingly high AHI the next morning. I literally have not touched alcohol since then, it has been years.
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How are you all procuring SGLTi unless you have a formal indication? Indian pharmacy?
I’m sure my doc would write an rx if I wanted him to, just as he did for metformin that I didn’t ‘need’, but regardless, I do get them sent from India for cost reasons. There are many sources available, and I think that is what most, if not all, of us do.
Most of us who have been using SGLTi’s have been getting them from India, but now companies are prescribing them in the US, for example Healthspan: Doctor-Prescribed SGLT-2 Inhibitor for Longevity and Healthspan
I think AgelessRX is also doing it, or will be soon. But generally doctors are not prescribing these drugs to healthy people yet.
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The flozins are generally too expensive in the USA for most to consider. India provides a cost-effective quality solution.
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Yeah, I looked it up at Mark Cuban’s Costplus (which is most economical of all pharmacies) and its over 10 bucks a pill
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India is around $60 for a month’s supply, or about $2 per pill.
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Aren’t these going generic soon?
They are starting to… and there seems to be at least one that may be relatively inexpensive:
The SGLT2i bexagliflozin was approved in January 2023 as adjunctive therapy to lower blood glucose in patients with type 2 diabetes. Patients with an estimated glomerular filtration rate less than 30 are excluded on the label (4). Bexagliflozin (brand name Brenzavvy) was not expected to have much success as a late entrant into the field, especially since established SGLT2i, including dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance), have additional cardiovascular and kidney-labeled indications. However, in a novel marketing approach, bexagliflozin is available exclusively through Cost Plus Drugs at a cash price of approximately $50 per month (5). There are no required patient assistance programs or other qualifying steps to access the medication (Table 1). Prescribing physicians should exercise their best clinical judgment to determine if the evidence for a class effect of the SGLT2i is enough to warrant off-label use of bexagliflozin to provide benefit among patients with cardiovascular and kidney diseases.
AstraZeneca’s Farxiga (dapagliflozin) does not go off patent until 2025, and in 2021, AstraZeneca successfully defended its patent against a challenge from a manufacturer of generic medications (6). However, generic dapagliflozin is now available in the United States. In a marketing strategy familiar to Costco shoppers, who purchase brand name products sold under the Kirkland label at a significant discount, AstraZeneca has licensed Prasco to sell dapagliflozin as an authorized generic. The medication is manufactured in the same facility as the branded product and is identical other than the packaging (7). There is the potential for savings to be passed on to the consumer, although the savings may also be captured by pharmacy benefit managers and the pharmacies.
Source: Newer Options for SGLT2 Inhibitors in the United States in: Kidney News Volume 16 Issue 4 (2024)
Related:
FDA Moves Generic Dapagliflozin a Step Closer to US Sales
Mitchel L. Zoler, PhD
February 23, 2022
However, the Zydus formulations of dapagliflozin will likely not soon appear on the US market because in October 2021 the company failed in its bid in US District Court to invalidate the patent that AstraZeneca holds on dapagliflozin through 2025 based on a claim of “obviousness.” The court dismissed the Zydus claims and upheld the validity of the patent.
https://www.medscape.com/viewarticle/969050
https://www.goodrx.com/classes/sglt2-inhibitors/sglt2-inhibitors-list
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That’s very interesting.
Looks like it’s as good as dapagliflozin:
Efficacy and safety of bexagliflozin compared with dapagliflozin as an adjunct to metformin in Chinese patients with type 2 diabetes mellitus: A 24-week, randomized, double-blind, active-controlled, phase 3 trial
For the primary endpoint of change in HbA1c from baseline to week 24, the main objective to demon-
strate that bexagliflozin was noninferior to dapagliflozin
was achieved. The similar reductions in HbA1c observed
with bexagliflozin and dapagliflozin suggest that both
SGLT2 inhibitors are effective in glycemic control.
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LOL, I did the same thing - immediately started scouring PubMed for info about bexagliflozin. I did find that it works in cats, which is always nice to know (for us, cat owners) as diabetes is very prevalent among cats. So it’s comforting to know that as you’re popping your SGLT2i, you might give some to your cat - the little guys are on the same journey as we are: rapamycin, sglt2i etc. I posted the relevant study in a cat thread although a bit OT as the thread is about rapamycin.
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I’ve also seen the one on humans and cat. I found it was rather funny.
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I asked Consensus about a non-diabetic taking an SGLT2 inhibitor for longevity and the response was below. Would be interested if anyone has thoughts about this response:
based on current evidence, I would not recommend that a healthy, non-diabetic person take empagliflozin (or any SGLT2 inhibitor) for general health or longevity. Here’s why:
- No Proven Benefit in Healthy People
- There are no clinical trials showing that empagliflozin improves health outcomes or extends lifespan in non-diabetics. Most studies focus on diabetics or those with heart failure or chronic kidney disease.
- Mechanism Doesn’t Offer Advantage Without Hyperglycemia
- Empagliflozin works by causing excess glucose to be excreted in urine. If your glucose levels are normal, there’s little to excrete—so the drug does almost nothing.
- Risks Without a Clear Benefit
-
Known side effects include:
- Genital and urinary tract infections
- Volume depletion and dehydration
- Electrolyte imbalances
- Rare risk of diabetic ketoacidosis (DKA), even in non-diabetics
(Simes & MacGregor, 2019)
SGLT2i offer kidney protection in CDK patients with and without diabetes.
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I’d go back through this thread and look at the many studies shared, because the above statement is simply false. SGLT2 receptors are found in multiple organs/tissues, including the heart, blood vessels, brain, etc. Mechanisms for beneficial effects exist that have nothing to do with glucose excretion in the urine.
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