Adverse effects of SGLT2 inhibitors in cats

In this interview, Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, discusses the adverse effects associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use in cats, specific to Senvelgo (velagliflozin oral solution) and Bexacat (bexagliflozin tablets). She discusses gastrointestinal symptoms, ketosis and diabetic ketoacidosis (DKA), hypoglycemia, and more.

Below is a partial transcript:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): As far as side effects, the most common are gastrointestinal. And right now there are 3 published papers, 2 on Senvelgo, one on Bexacat. And in those papers, the 2 most common side effects were soft stool and vomiting.

Which was number 1 and which was number 2 actually differs between the studies, and I don't think that's any real difference between Bexacat and Senvelgo, I think that was the luck of the population.

If you read the package inserts, it says that diarrhea was the side effect, and it really makes it sound a lot scarier than it is. The use of diarrhea was an FDA-mandated term, and it was any loosening of the stool and owners were told to watch the litter box like a hawk and report anything, so I don't know that it's really real-life. The incidence, though, of soft stools was somewhere between about 30% and 50% which again, sounds scary, and it's not that scary.

If it happens, it typically happens in the first week, it's self-limiting, and it goes away. There were a couple cats that had diarrhea that was severe enough that the owner stopped the drug. But that was an exception, rather than the rule by far.

Vomiting happened once or twice, typically. It was random, it's not associated with anything. You're giving an oral medication to a cat, so of course, they're going to vomit randomly—they're cats. So, vomiting I don't think was out of the realm of what you would expect with a cat getting an oral medication...