Segluromet: The Ultimate Guide to Mastering Type 2 Diabetes Management

Segluromet is a prescription medication used to lower blood sugar levels in adults with type 2 diabetes. It combines two active ingredients: ertugliflozin and metformin hydrochloride. Ertugliflozin belongs to a class of drugs called SGLT2 inhibitors, while metformin is a biguanide. This article provides comprehensive information about Segluromet, including its uses, how it works, dosage, side effects, precautions, and potential interactions.

What is Segluromet and What is It Used For?

Segluromet is a combination medication containing ertugliflozin and metformin, both of which work to lower blood sugar levels in individuals with type 2 diabetes. It is not intended for use in individuals with type 1 diabetes. Your healthcare provider may prescribe Segluromet for other conditions as deemed appropriate.

Metformin is widely considered the safest first-line medication for type 2 diabetes. With decades of clinical use and extensive safety data, it remains the preferred initial treatment according to the American Diabetes Association (ADA).

How Segluromet Works

Segluromet contains ertugliflozin L-pyroglutamic acid, which is a SGLT2 inhibitor, and metformin hydrochloride, a biguanide class drug. Segluromet works through multiple mechanisms to help regulate blood glucose levels:

Reduces Glucose Absorption: Segluromet decreases the amount of glucose your body absorbs from things you eat and drink.
Decreases Liver Glucose Production: Segluromet reduces the amount of glucose that your liver makes.
Enhances Insulin Sensitivity: Segluromet also helps your body’s own insulin to work better. (Insulin is a hormone that helps your body use glucose as a source of energy.)
Promotes Glucose Excretion: Segluromet helps your body get rid of sugar when you pee. Ertugliflozin works by helping the kidneys get rid of glucose from your bloodstream.

Dosage and Administration

Segluromet is available in oral tablet form in the following strengths:

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2. 5 mg ertugliflozin/500 mg metformin
3. 5 mg ertugliflozin/1000 mg metformin
4. 5 mg ertugliflozin/500 mg metformin
5. 5 mg ertugliflozin/1000 mg metformin

How should I use this medication? Take this medication by mouth with water. Take it as directed on the prescription label at the same time every day. Take it with food at the start of a meal. Keep taking it unless your care team tells you to stop.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose? If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Storage Instructions

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.

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If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

Potential Side Effects

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

Allergic reactions-skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Dehydration-increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
Diabetic ketoacidosis (DKA)-increased thirst or amount of urine, dry mouth, fatigue, fruity odor to breath, trouble breathing, stomach pain, nausea, vomiting
Genital yeast infection-redness, swelling, pain, or itchiness, odor, thick or lumpy discharge
High lactic acid level-muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
Infection or redness, swelling, tenderness, or pain in the genitals, or area from the genitals to the back of the rectum
Low vitamin B12 level-pain, tingling, or numbness in the hands or feet, muscle weakness, dizziness, confusion, trouble concentrating
New pain or tenderness, change in skin color, sores or ulcers, infection of the leg or foot
Urinary tract infection (UTI)-burning when passing urine, passing frequent small amounts of urine, bloody or cloudy urine, pain in the lower back or sides

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

Diarrhea
Gas
Headache
Nausea
Stomach pain
Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects.

Serious Side Effects

While less common, Segluromet can cause serious side effects that require immediate medical attention:

Severe Allergic Reactions: Symptoms include breathing problems, wheezing, racing heart, fever, swollen lymph nodes, swelling of the face, lips, mouth, tongue, or throat, trouble swallowing, itching, skin rash, hives, nausea, vomiting, dizziness, and joint pain.
Diabetic Ketoacidosis (DKA): A serious complication of diabetes that can be life-threatening. Symptoms include nausea, vomiting, stomach pain, fatigue, confusion, difficulty breathing, fruity breath odor, and very high blood sugar levels.
Lactic Acidosis: A buildup of lactic acid in the blood, which can be serious. Symptoms include general ill feeling, muscle pain, difficulty breathing, drowsiness, and stomach pain.
Dehydration: Segluromet can cause dehydration, leading to low blood pressure and kidney damage. Symptoms include dizziness, lightheadedness, weakness, confusion, unsteadiness, decreased urination, swelling in the legs, ankles, and feet, loss of appetite, nausea, difficulty breathing, chest pain, seizures, and extreme thirst.
Urosepsis and Pyelonephritis: Serious infections that may require hospitalization. Symptoms include dark, cloudy, or bloody urine, fever, chills, loss of appetite, frequent urination, pain when urinating, and pain in the lower back, side, or groin.
Low Blood Sugar (Hypoglycemia): Can occur, especially when combined with insulin or other diabetes medications. Symptoms include headache, crankiness, hunger, dizziness, blurred vision, slurred speech, sweating, jitteriness, fast heartbeat, and seizures.
Necrotizing Fasciitis (Fournier’s Gangrene): A rare but very serious infection that can lead to death. Symptoms include pain, redness, tenderness, or swelling of the perineum, fever, and a general feeling of illness.
Vitamin B12 Deficiency: May lead to anemia. Symptoms include unusual weakness, cold hands and feet, fast heartbeat, pale skin, dizziness, and shortness of breath.
Amputations: People who take Segluromet may be more likely to have an amputation than people who do not take Segluromet. Inspect your feet and legs regularly and contact your healthcare provider right away if you have sores, ulcers, or new pain or tenderness, as these may lead to the need for an amputation if not treated.

Common Side Effects

The most common side effects of Segluromet include:

Yeast infection of the vagina or penis
Diarrhea
Nausea/vomiting
Gas
Stomach pain, upset stomach
Feeling unusually weak or tired
Headache

Precautions and Warnings

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

Changes to diet, eating less
Changes to your insulin dose
Dehydration
Diet low in salt
Frequently drink alcohol
Have had an amputation
Have had diabetic ketoacidosis (DKA)
Have had foot sores caused by diabetes
Have had genital infections
Have had urinary tract infections (UTIs)
Having a CT or X-ray scan
Having surgery
Have or have had pancreatitis
Heart attack
Heart disease
Impaired blood circulation, peripheral vascular disease
Infection
Irregular menstrual cycles
Kidney disease
Liver disease
Low levels of calcium in your blood
Low levels of vitamin B in your blood
Nerve pain, tingling or numbness in the hands or feet
Stroke
Trouble passing urine
Type 1 diabetes
An unusual or allergic reaction to ertugliflozin, metformin, other medications, foods, dyes, or preservatives
Pregnant or trying to get pregnant
Breastfeeding

Contraindications

Segluromet is contraindicated in individuals with the following conditions:

Allergy to ertugliflozin, metformin, or any of the ingredients in Segluromet
Liver problems
Kidney problems
Metabolic acidosis, including diabetic ketoacidosis

General Precautions

Take Segluromet as prescribed by your healthcare provider.
Do not share Segluromet with others.
Keep Segluromet out of the reach of children.
Certain conditions that cause increased stress on your body, like fever, trauma (such as a car accident), infection, or surgery can change the amount of diabetes medicines you need to take to control your diabetes. Talk to your healthcare provider if you have any of these conditions to decide if your medicine needs to be changed.
Talk to your healthcare provider about how to prevent, recognize, and manage low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and diabetes-related problems.
People who are 65 years or older can be at greater risk for some side effects from Segluromet. Talk to your healthcare provider about your risks if you are in this age group.
People who have kidney problems can be at greater risk for some side effects from Segluromet. Talk to your healthcare provider about your risks if you have kidney problems.
Take Segluromet with food to help decrease the chance you will have an upset stomach.
Segluromet will cause your pee to test positive for glucose (sugar).
Your healthcare provider will run lab tests to see how well your kidneys are working and make sure you are not dehydrated before starting Segluromet.

Specific Precautions

Risk factors for diabetic ketoacidosis: Tell your healthcare provider if you have type 1 diabetes, a history of diabetic ketoacidosis, a decrease in your insulin dose, a serious infection, are on a low-salt diet or ketogenic diet, drink alcohol often, have pancreas problems, are dehydrated, or are eating less than normal.
Risk factors for lactic acidosis: Tell your healthcare provider if you have kidney problems, liver problems, heart problems, drink alcohol often, have an upcoming medical test that uses contrast, are having surgery, are dehydrated, have a severe infection, or have had a stroke.
Previous amputation, nerve damage, or blood flow problems: Tell your healthcare provider if you had a previous amputation, or have nerve damage, or blood flow problems.
History of genital yeast infections: Tell your healthcare provider if you have a history of genital (penis or vagina) yeast infections.
History of kidney or bladder infections or difficulty peeing: Tell your healthcare provider about any kidney or bladder infections or if you have trouble peeing.
Have surgery scheduled: Talk to your healthcare provider if you are having surgery so you know when to stop and restart your Segluromet.
Pregnancy: Segluromet may cause harm to an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.
Breastfeeding: It is not known if Segluromet passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed.
Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy.

Interactions

What may interact with this medication?

Do not take this medication with any of the following:

Certain contrast agents used before CT, MRI, or X-ray scans

This medication may also interact with the following:

Acetazolamide
Alcohol
Cimetidine
Dichlorphenamide
Dolutegravir
Lithium
Ranolazine
Topiramate
Vandetanib
Zonisamide

Some medications may affect your blood sugar levels or hide the symptoms of low blood sugar (hypoglycemia). Talk with your care team about all the medications you take. They may suggest checking your blood sugar levels more often.

Medications that may affect your blood sugar levels include:

Alcohol
Certain antibiotics, such as ciprofloxacin, levofloxacin, sulfamethoxazole; trimethoprim
Certain medications for blood pressure or heart disease, such as benazepril, enalapril, lisinopril, losartan, valsartan
Certain medications for mental health conditions, such as fluoxetine or olanzapine
Diuretics, such as hydrochlorothiazide (HCTZ)
Estrogen and progestin hormones
Other medications for diabetes
Steroid medications, such as prednisone or cortisone
Testosterone
Thyroid hormones

Medications that may mask symptoms of low blood sugar include:

Beta-blockers, such as atenolol, metoprolol, propranolol
Clonidine
Guanethidine
Reserpine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Drug Interactions

Segluromet may interact with the following medications:

Lithium
Diuretics
Carbonic anhydrase inhibitors
Other medicines for diabetes
Other medicines that may alter blood levels of Segluromet
Medicines that can increase blood sugar

Food and Drink Interactions

There are no known interactions between Segluromet and foods or drinks.
Being on a low-salt diet while taking Segluromet may increase your risk of dehydration.
Being on a ketogenic diet while taking Segluromet may increase your risk of ketoacidosis.
Drinking too much alcohol while taking Segluromet may increase your risk of diabetic ketoacidosis.

Monitoring and Follow-Up

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

You may need blood work done while you are taking this medication. Your care team will monitor your HbA1C (A1C). This test shows what your average blood sugar (glucose) level was over the past 2 to 3 months.

Know the symptoms of low blood sugar and know how to treat it. Always carry a source of quick sugar with you. Examples include hard sugar candy or glucose tablets. Make sure others know that you can choke if you eat or drink if your blood sugar is too low and you are unable to care for yourself. Get medical help at once.

Tell your care team if you have high blood sugar. Your medication dose may change if your body is under stress. Some types of stress that may affect your blood sugar include fever, infection, and surgery.

Wear a medical ID bracelet or chain. Carry a card that describes your condition. List the medications and doses you take on the card.

Make sure you stay hydrated while taking this medication. Drink water often. Eat fruits and veggies that have a high water content. Drink more water when it is hot or you are active. Talk to your care team right away if you have fever, infection, vomiting, diarrhea, or if you sweat a lot while taking this medication. The loss of too much body fluid may make it dangerous for you to take this medication.

Tell your care team you are taking this medication before you have surgery or an imaging scan, such as a CT or X-ray. You may need to stop taking this medication for a while before and after the procedure. Your care team will tell you when to stop and when to start taking it again.

Drinking alcohol with this medication can increase the risk of side effects.

Make sure you get enough vitamin B12 while you are taking this medication. Discuss the foods you eat and the vitamins you take with your care team.

This medication may cause you to ovulate, which may increase your chances of becoming pregnant. Talk with your care team about contraception while you are taking this medication. Contact your care team if you think you might be pregnant.

Regular Monitoring

Regular visits to your healthcare provider are necessary to monitor your progress and check for any unwanted effects.
Blood and urine tests may be required to check for unwanted effects.
Your healthcare provider will monitor your HbA1c levels to assess your average blood sugar control over the past 2-3 months.

Important Considerations

Know the symptoms of low blood sugar and how to treat it. Always carry a source of quick sugar with you.
Tell your healthcare provider if you experience high blood sugar.
Wear a medical ID bracelet or chain and carry a card that describes your condition and medications.
Stay hydrated by drinking water often.
Inform your healthcare provider before undergoing surgery or imaging scans.

Lifestyle Modifications

Segluromet is most effective when used in conjunction with lifestyle modifications, including:

Diet: Following a balanced meal plan suitable for people at risk of hypoglycemia includes: soup, such as lentil and quinoa; grilled fish with broccoli, peas, and sweet potato; broccoli salad with artichokes, black beans, and sun-dried tomatoes; chicken vege stir fry with zucchini, carrots, and broccoli; and vegetarian lentil tacos.
Exercise: Regular physical activity helps improve insulin sensitivity and lower blood sugar levels.
Weight Management: Maintaining a healthy weight can improve blood sugar control and reduce the risk of diabetes-related complications.

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