Meta Information
ID:ertugliflozin
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/antidiabetic-medications
Target name:
Insulin and Insulin Secretagogues (e.g., Sulfonylureas) (Insulin Secretagogues)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
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 using these medications concomitantly of this risk and educate them on the signs and symptoms of hypoglycemia.
Label source:
Action type:
adjust_with_prescriber
Target id:
/class/loop-diuretics
Target name:
Loop Diuretics (e.g., Furosemide)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
This combination should be avoided if possible; if necessary, close monitoring of blood pressure, kidney function, and hydration status is required.
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:
avoid
Target id:
/condition/renal-impairment
Target name:
Severe Renal Impairment (eGFR < 30)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Specific Populations Patients with Renal Impairment In a clinical pharmacology study in patients with type 2 diabetes mellitus and mild, moderate, or severe renal impairment (as determined by eGFR), following a single-dose administration of 15 mg STEGLATRO, the mean increases in AUC of ertugliflozin were 1.6-, 1.7-, and 1.6-fold, respectively, for mild, moderate and severe renally impaired patients, compared to subjects with normal renal function.
Label source:
Action type:
avoid
Target id:
/dietary/ketogenic-diet
Target name:
Ketogenic Diet
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Ertugliflozin should not be used while on a 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 stress of surgery, fasting, and anesthesia increases the risk of dehydration and diabetic ketoacidosis (DKA). Ertugliflozin should be stopped beforehand.
Actionable advice:
Ertugliflozin should be discontinued at least 3 days prior to any major surgery or procedure.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
For patients who undergo scheduled surgery, consider temporarily discontinuing STEGLATRO for at least 4 days prior to surgery [see Clinical Pharmacology (12.2, 12.3)].
Label source:
FDA label: Ertugliflozin (STEGLATRO)
Action type:
avoid
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking ertugliflozin while already dehydrated can lead to severe volume depletion, low blood pressure, and acute kidney injury.
Actionable advice:
Adequate fluid intake should be maintained and any existing dehydration corrected before starting or continuing 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:
Signs and symptoms are consistent with dehydration and severe metabolic acidosis and include nausea, vomiting, abdominal pain, generalized malaise, and shortness of breath.
Label source:
Action type:
separate
Target id:
/dietary/water
Target name:
Adequate Fluid Intake
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
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 for hypotension, and to have adequate fluid intake.
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:
Ertugliflozin is not recommended during the second and third trimesters of pregnancy due to potential risks to fetal kidney development.
Actionable advice:
This should be strictly avoided during pregnancy, especially in the second and third trimesters.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In animal studies, adverse renal changes were observed in rats when ertugliflozin was administered during a period of renal development corresponding to the late second and third trimesters of human pregnancy.
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 ertugliflozin passes into breast milk, but due to the potential for serious adverse reactions in the nursing infant, it is not recommended.
Actionable advice:
This should not be used 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, advise women that the use of STEGLATRO is not recommended while breastfeeding.
Label source:
Action type:
avoid
Target id:
/class/sglt2-inhibitors
Target name:
Other SGLT2 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Ertugliflozin should never be taken with another SGLT2 inhibitor like canagliflozin, dapagliflozin, or empagliflozin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Treatment with SGLT2 inhibitors increases the risk for urinary tract infections.
Label source:
Action type:
avoid
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:
Hours before target:
0
Hours after target:
0
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:
The 1,5-AG assay should not be used to monitor blood sugar control; 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:
monitor
Target id:
/biomarker/urine-glucose-test
Target name:
Urine Glucose Test
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Urine glucose tests should not be used to monitor blood sugar control; they will always be positive while on 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:
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:
/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 kidney blood flow, and when combined with the dehydrating effect of ertugliflozin, the risk of acute kidney injury is significantly increased.
Actionable advice:
Chronic use of NSAIDs is best avoided; if used short-term, adequate hydration and monitoring of kidney function 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/ace-inhibitors
Target name:
ACE Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Blood pressure and kidney function should be monitored regularly when using this combination, especially upon initiation.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
8.6 Race
ACE inhibitors, including Zestril, have an effect on blood pressure that is less in black patients than in non blacks.
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:
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:
Blood pressure and kidney function should be monitored regularly when using this combination, especially upon initiation.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
1 INDICATIONS AND USAGE Valsartan tablets are an angiotensin II receptor blocker (ARB) indicated for: • Hypertension , to lower blood pressure in adults and children 1 year and older.
Label source:
Action type:
monitor
Target id:
/dietary/alcohol-acute
Target name:
Alcohol (Acute Consumption)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Alcohol can increase the risk of both low blood sugar (hypoglycemia) and diabetic ketoacidosis (DKA) when taken with ertugliflozin.
Actionable advice:
Alcohol consumption 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:
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:
/class/broad-spectrum-inducers
Target name:
Broad-Spectrum Metabolic Enzyme Inducers (e.g., Rifampin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Coadministration of ertugliflozin with multiple doses of 600 mg once-daily rifampin (an inducer of UGT and CYP enzymes) resulted in approximately 39% and 15% mean reductions in ertugliflozin AUC and C max , respectively, relative to ertugliflozin administered alone.
Label source:
Action type:
monitor
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 ertugliflozin, increasing their risk of falls, low blood pressure, and kidney problems.
Actionable advice:
This is best used with caution in older adults, with adequate hydration and monitoring of blood pressure and kidney function.
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, assess and correct volume status in patients with renal impairment or low systolic blood pressure, elderly patients, or patients on diuretics.
Label source:
Action type:
monitor
Target id:
/condition/history-of-gmi
Target name:
History of Genital Mycotic Infections
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
The increased risk is worth keeping in mind; maintaining good hygiene helps, and seeking treatment if symptoms occur is a good idea.
Validation status:
validated_via_expert_review
Evidence tier:
tier_c
Evidence basis:
expert_review_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
yeast infection
Label source:
FDA label: Ertugliflozin (STEGLATRO)
Action type:
informational_none
Target id:
/condition/peripheral-vascular-disease
Target name:
Peripheral Vascular Disease or History of Amputation
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.2 Lower Limb Amputation In a long-term cardiovascular outcomes study [see Clinical Studies (14.2) ] , in patients with type 2 diabetes mellitus and established cardiovascular disease, the occurrence of non-traumatic lower limb amputations was reported with event rates of 4.7, 5.7, and 6.0 events per 1,000 patient-years in the placebo, STEGLATRO 5 mg, and STEGLATRO 15 mg treatment arms, respectively.
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:
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:
A dose is generally best taken in the morning, with or without food.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
The recommended starting dose of STEGLATRO is 5 mg once daily, taken in the morning, with or without food.
Label source:
FDA label: Ertugliflozin (STEGLATRO)
Action type:
informational_none