The TGA has urged doctors to be vigilant for diabetic ketoacidosis in patients taking sodium glucose co-transporter inhibitors).

The safety notice applies to drugs such as dapagliflozin (Forxiga, Xigduo XR), canagliflozin (Invokana) and empagliflozin (Jardiance).

The presentation of DKA was sometimes atypical and glucose levels in some cases were only mildly elevated at less than 11 mmol/L (200 mg/dL), the notice published last week says.

“You should inform patients of signs and symptoms of metabolic acidosis and advise them to immediately seek medical advice if they develop any such signs or symptoms,” the TGA advises.

The underlying mechanism for SGLT2 inhibitor-associated DKA has not been established. However some of the reported cases involved off-label use in patients with type 1 diabetes.