Meta Information
ID:bexagliflozin
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/diuretics
Target name:
Diuretics (Water Pills)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin causes fluid loss through urination; combining it with other diuretics significantly increases the risk of dehydration, low blood pressure, and acute kidney injury.
Actionable advice:
Co-administration should be avoided, or used only under strict medical supervision with careful monitoring and potential dose adjustments.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Before initiating BRENZAVVY, assess and correct volume status in patients with impaired renal function or low systolic blood pressure, elderly patients or patients on diuretics.
Label source:
Action type:
avoid
Target id:
/class/antidiabetic-medications
Target name:
Insulin and Insulin Secretagogues (e.g., Sulfonylureas)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining bexagliflozin with insulin or drugs that stimulate insulin release (like sulfonylureas or glinides) dramatically increases the risk of dangerously low blood sugar (hypoglycemia).
Actionable advice:
Requires significant dose reduction of the insulin or secretagogue and frequent blood glucose monitoring when starting bexagliflozin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.5 Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues Insulin and insulin secretagogues (e.g., sulfonylureas) are known to cause hypoglycemia.
Label source:
Action type:
adjust_with_prescriber
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin's effectiveness and safety are dependent on kidney function. It is not recommended for individuals with an eGFR below 30 mL/min/1.73 m2 due to lack of efficacy and increased risk of adverse events.
Actionable advice:
This should not be used in severe kidney disease (eGFR < 30); a doctor can advise on use with mild to moderate impairment.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The safety and efficacy of BRENZAVVY in adults with type 2 diabetes mellitus and moderate renal impairment (eGFR between 30 and 60 mL/min/1.73 m 2 ) were evaluated in Trial 5 [see Clinical Studies ( 14.4 )] .
Label source:
Action type:
avoid
Target id:
/intervention/ketogenic-diet
Target name:
Ketogenic Diet
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
A ketogenic diet promotes the production of ketones, and bexagliflozin can also increase ketones, leading to a high risk of a serious condition called euglycemic diabetic ketoacidosis (DKA).
Actionable advice:
Bexagliflozin should not be used while following a strict ketogenic or very low-carbohydrate diet.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Precipitating conditions for diabetic ketoacidosis or other ketoacidosis include under-insulinization due to insulin dose reduction or missed insulin doses, acute febrile illness, reduced caloric intake, ketogenic diet, surgery, volume depletion, and alcohol abuse.
Label source:
Action type:
avoid
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 metabolic stress of surgery, combined with fasting, significantly increases the risk of developing ketoacidosis. Bexagliflozin should be temporarily discontinued to mitigate this risk.
Actionable advice:
Bexagliflozin should be stopped at least 3 days before any scheduled major surgery, and it is important to talk to a doctor about when to restart.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
( 2.1 ) • Withhold BRENZAVVY for at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting ( 2.3 ).
Label source:
Action type:
informational_none
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin is not recommended during pregnancy, particularly in the second and third trimesters, due to potential risks to the developing fetus's kidneys.
Actionable advice:
This should be strictly avoided during pregnancy.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
8 USE IN SPECIFIC POPULATIONS Pregnancy: Advise females of the potential risk to a fetus especially during the second and third trimesters.
Label source:
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is not known if bexagliflozin passes into breast milk, but due to the potential for serious adverse reactions in a breastfed infant, it is not recommended.
Actionable advice:
It should be avoided completely while breastfeeding.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Because of the potential for serious adverse reactions in a breastfed infant, including the potential for bexagliflozin to affect postnatal renal development, advise patients that use of BRENZAVVY is not recommended while breastfeeding.
Label source:
Action type:
avoid
Target id:
/class/ace-inhibitors
Target name:
ACE Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The combination of bexagliflozin's diuretic effect with the blood pressure-lowering effect of ACE inhibitors can increase the risk of dehydration, hypotension, and acute kidney injury.
Actionable advice:
This is best used with caution and with adequate hydration; regular monitoring of blood pressure and kidney function is recommended.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
7.4 Dual Blockade of the Renin-Angiotensin System (RAS)
Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with
increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure)
compared to monotherapy.
Label source:
Action type:
monitor
Target id:
/class/arbs
Target name:
Angiotensin II Receptor Blockers (ARBs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The combination of bexagliflozin's diuretic effect with the blood pressure-lowering effect of ARBs can increase the risk of dehydration, hypotension, and acute kidney injury.
Actionable advice:
This is best used with caution and with adequate hydration; regular monitoring of blood pressure and kidney function is recommended.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
7.4 Dual Blockade of the Renin-Angiotensin System (RAS) Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.
Label source:
Action type:
monitor
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
NSAIDs can reduce blood flow to the kidneys. When combined with the volume-depleting effect of bexagliflozin, the risk of acute kidney injury is significantly increased.
Actionable advice:
Chronic use of NSAIDs is best avoided; for occasional use, adequate hydration and the lowest effective dose are best.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Before taking NSAIDS, tell your healthcare provider about all of your medical conditions,
including if you:
• have liver or kidney problems
• have high blood pressure
• have asthma
Reference ID: 5482829
• are pregnant or plan to become pregnant.
Label source:
Action type:
avoid
Target id:
/class/broad-spectrum-inducers
Target name:
UGT Enzyme Inducers (e.g., Rifampin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Certain drugs, like the antibiotic rifampin, can accelerate the metabolism and clearance of bexagliflozin from the body, potentially reducing its effectiveness at lowering blood sugar.
Actionable advice:
If co-administration is necessary, your doctor may need to increase the dose of bexagliflozin and monitor glucose levels.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Effect of Other Drugs on the Pharmacokinetics of Bexagliflozin Note: Rifampin dosing over 5 days, the regimen may not represent the maximal impact on bexagliflozin exposure.
Label source:
Action type:
monitor
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin promotes fluid loss, which can worsen existing dehydration and lead to severe complications like low blood pressure, dizziness, and kidney failure.
Actionable advice:
It is a good idea to be well-hydrated before starting and to maintain good fluid intake, especially during illness or hot weather.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Inform patients that dehydration may increase the risk of hypotension, and to maintain adequate fluid intake.
Label source:
Action type:
informational_none
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Older adults are more susceptible to the dehydrating effects of bexagliflozin, which increases their risk of low blood pressure (orthostatic hypotension), falls, and kidney problems.
Actionable advice:
This is best used with caution in older adults, with adequate fluid intake and monitoring for dizziness upon standing.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ) [see Use in Specific Populations ( 8.6 )] , elderly patients, patients with low systolic blood pressure, or patients on loop diuretics may be at increased risk for volume depletion or hypotension.
Label source:
Action type:
monitor
Target id:
/condition/alcohol-chronic
Target name:
Chronic Alcohol Use (Alcohol Use Disorder)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Heavy alcohol use can impair glucose production, increase the risk of dehydration, and elevate ketone levels, all of which can heighten the risk of hypoglycemia and ketoacidosis with bexagliflozin.
Actionable advice:
Alcohol intake is best limited, and binge drinking is best avoided while taking this medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Educate all patients on precipitating factors (such as insulin dose reduction or missed insulin doses, infection, reduced caloric intake, ketogenic diet, surgery, dehydration, and alcohol abuse) and symptoms of ketoacidosis
Label source:
FDA label: Bexagliflozin (Brenzavvy)
Action type:
avoid
Target id:
/intervention/lithium
Target name:
Lithium
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin can increase the kidneys' elimination of lithium, potentially lowering its concentration in the blood and reducing its therapeutic effect for conditions like bipolar disorder.
Actionable advice:
If taking lithium, your doctor should monitor your lithium levels closely after starting, stopping, or changing the dose of bexagliflozin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Intervention Monitor serum lithium concentration more frequently upon BRENZAVVY initiation and discontinuation.
Label source:
Action type:
monitor
Target id:
/biomarker/1-5-ag-assay
Target name:
1,5-Anhydroglucitol (1,5-AG) Assay
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin's mechanism of forcing glucose into the urine makes the 1,5-AG test, a marker of short-term glycemic control, completely unreliable for monitoring blood sugar.
Actionable advice:
The 1,5-AG test should not be used to monitor blood sugar control while taking this medication; HbA1c or blood glucose monitoring is appropriate instead.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Interference with 1,5-anhydroglucitol (1,5-AG) Assay Clinical Impact Measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors.
Label source:
Action type:
avoid
Target id:
/biomarker/urine-glucose-test
Target name:
Urine Glucose Test
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
This medication works by causing glucose to be excreted in the urine, so urine glucose tests will always be positive and cannot be used to monitor for high blood sugar.
Actionable advice:
Urine glucose tests should not be relied upon for glycemic monitoring; blood glucose tests should be used instead.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Positive Urine Glucose Test Clinical Impact SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests.
Label source:
Action type:
monitor
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:
2
Description:
Taking bexagliflozin in the morning helps align its diuretic (increased urination) effect with daytime hours, reducing the chance of sleep disruption from needing to urinate at night (nocturia).
Actionable advice:
A dose is generally best taken in the morning, with or without food, to minimize nighttime urination.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
You should take Brenzavvy in the morning.
Label source:
Anecdotal: WebMD
Action type:
informational_none
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bexagliflozin may slightly increase the concentration of digoxin in the blood, which could potentially increase its effects and risk of side effects.
Actionable advice:
If taking both medications, your doctor may wish to monitor your digoxin levels when starting or adjusting bexagliflozin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Bexagliflozin had no clinically relevant effect on the pharmacokinetics of metformin, glimepiride, sitagliptin, and digoxin ( Figure 2 ).
Label source:
Action type:
monitor