====== Sotagliflozin ======

Sotagliflozin is a dual SGLT2 and SGLT1 inhibitor used for heart failure and diabetes.

Unlike other SGLT2 inhibitors, sotagliflozin also inhibits SGLT1 in the intestine.

→ [[endocrine:sglt2:start|SGLT2 Inhibitors Overview]]

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===== Mechanism of Action =====

SGLT2 inhibition (kidney):

• Blocks glucose reabsorption in proximal tubule
• Causes glucosuria
• Causes mild natriuresis
• Reduces intraglomerular pressure

SGLT1 inhibition (intestine):

• Reduces postprandial glucose absorption
• Blunts post-meal glucose spikes

Net Effects:

• ↓ Blood glucose
• Mild osmotic diuresis
• ↓ Preload
• ↓ Blood pressure
• Cardiorenal protection

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===== Indications =====

==== Heart Failure ★ ====

Indicated for:

• HFrEF
• HFpEF
• Worsening heart failure

Benefits:

• ↓ HF hospitalization
• ↓ Cardiovascular events
• Works with or without diabetes

→ [[cardio:heart_failure:start|Heart Failure Module]]

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==== Type 2 Diabetes Mellitus ====

• Improves glycemic control
• Blunts postprandial glucose rise

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===== Major Trials =====

SOLOIST-WHF:

• Reduced cardiovascular death and HF events
• Studied in patients recently hospitalized for worsening HF

SCORED:

• Reduced cardiovascular events in diabetic patients with CKD

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===== Adverse Effects =====

Common:

• Genital mycotic infections
• Diarrhea (more common due to SGLT1 inhibition)
• Volume depletion
• Hypotension

Serious (rare):

• Euglycemic DKA
• Fournier gangrene

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===== Contraindications / Cautions =====

• Type 1 diabetes
• Severe dehydration
• Advanced renal impairment (indication-dependent)

Hold during:

• Acute illness
• Surgery
• Prolonged fasting

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===== Sotagliflozin vs Other SGLT2 Inhibitors =====

[[endocrine:sglt2:dapagliflozin|Dapagliflozin]] and [[endocrine:sglt2:empagliflozin|Empagliflozin]]:

  * • Pure SGLT2 inhibitors
  * • No intestinal SGLT1 inhibition

Sotagliflozin:

  * • Dual SGLT1 + SGLT2 inhibition
  * • Greater postprandial glucose reduction
  * • More GI side effects

All provide:

  * • Heart failure benefit
  * • Renal protection
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===== Clinical Pearls =====

✔ Dual SGLT1 and SGLT2 inhibitor  
✔ Reduces HF hospitalization  
✔ Useful after recent HF hospitalization  
✔ Causes more GI side effects than other gliflozins  
✔ Benefit independent of diabetes status  

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Related:

→ [[cardio:heart_failure:start|Heart Failure Module]]
→ [[endocrine:sglt2:start|SGLT2 Inhibitors Overview]]
→ [[cardio:intro:start|Cardiovascular Modules]]