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Dosing Protocol

Updated

Bexagliflozin Starting Dose:

  • Patients will start with 20 mg once daily dose, taken before the first meal of the day. This helps to optimize the glucose-lowering effects.

Renal Function Considerations:

  • eGFR (estimated glomerular filtration rate) ≥ 60 mL/min/1.73 m²: 100–300 mg once daily can be used.
  • eGFR 30–59 mL/min/1.73 m²: 100 mg once daily is typically recommended, as increasing the dose may not provide significant additional benefits in this range.
  • eGFR < 30 mL/min/1.73 m²: Bexagliflozin is generally not recommended due to the risk of adverse effects, especially on renal function.

Special Populations: Dose adjustments may be required for patients who are elderly, have advanced kidney disease, or are taking other medications that affect blood pressure or kidney function.

Special Notes:

  • Patients with a history of hypotension, electrolyte imbalances, or volume depletion should ensure adequate hydration prior to starting the protocol.
  • Women of childbearing age should confirm they are not pregnant, as Canagliflozin is not recommended during pregnancy or breastfeeding.

Dietary Considerations

When taking SGLT-2 inhibitors, high-sugar meals can amplify certain side effects or reduce the drug's intended benefits. Here’s how:

  1. Increased Urinary Glucose Excretion:
    • SGLT-2 inhibitors increase glucose excretion through urine by inhibiting renal glucose reabsorption. A high-sugar meal introduces more glucose into the system, which may:
      • Exacerbate the frequency and urgency of urination.
      • Increase the risk of dehydration due to osmotic diuresis.
  2. Higher Risk of Genital and Urinary Tract Infections:
    • Excess glucose in urine provides a conducive environment for microbial growth, heightening the likelihood of infections such as:
      • Genital mycotic infections (e.g., yeast infections).
      • Urinary tract infections (UTIs), including more severe cases like urosepsis or pyelonephritis.
  3. Diminished Weight Management Benefits:
    • High-sugar meals can counteract Canagliflozin's benefits in improving body composition and reducing fat mass, as the calorie surplus from sugar is not fully offset by the drug's effects.
  4. Potential Electrolyte Imbalances:
    • Rapid glucose excretion can lead to loss of electrolytes such as sodium, potassium, and magnesium, increasing risks of muscle weakness, cramping, or arrhythmias.
  5. Gastrointestinal Discomfort:
    • High-sugar meals may amplify gastrointestinal bloating or nausea for those sensitive to changes in blood sugar levels.

By advising patients to avoid high-sugar meals, the goal is to maximize the therapeutic benefits of SGLT-2 inhibitors, reduce the risk of adverse events, and maintain stable glucose and electrolyte levels.

 

Labs we will monitor:

We will include in their membership a lab test at the 4 week mark to make sure their are no adverse reactions. We should also recommend a CGM program and metabolic health coaching so that patients can monitor their blood glucose levels on the program.

  • Renal Function:
    • Serum Creatinine and eGFR: To monitor kidney function, particularly because SGLT-2 inhibitors are contraindicated in patients with advanced kidney disease (eGFR < 30 mL/min/1.73 m²).
    • Frequency: Baseline, then periodically (every 3–6 months), especially if any kidney-related symptoms or side effects appear.
  • Electrolytes:
    • Serum Potassium: SGLT-2 inhibitors may cause hyperkalemia, particularly in patients with kidney disease or those taking other medications that affect potassium levels (e.g., ACE inhibitors or ARBs).
    • Serum Magnesium and Phosphate: Less commonly, SGLT-2 inhibitors may alter these electrolyte levels, so occasional monitoring is advisable, especially in patients with renal impairment.
  • Glucose Control:
    • Hemoglobin A1c (HbA1c): To assess long-term glucose control, aiming for at least quarterly monitoring in patients with diabetes.
    • Fasting Plasma Glucose (FPG): Periodic checks may also help evaluate day-to-day glucose management.
  • Volume Status and Dehydration Indicators:
    • Hematocrit and Blood Urea Nitrogen (BUN): SGLT-2 inhibitors may increase diuresis, leading to volume depletion. Elevated hematocrit and BUN may suggest dehydration or hypovolemia.
    • Blood Pressure: While not a lab test, regular BP monitoring is important as SGLT-2 inhibitors can cause hypotension, especially in patients on antihypertensive therapy.
  • Lipid Profile:
    • LDL Cholesterol: SGLT-2 inhibitors may modestly increase LDL cholesterol, so lipid levels should be monitored periodically, especially in patients with cardiovascular risk.
  • Ketone Levels (for at-risk patients):
    • Serum or Urine Ketones: SGLT2 inhibitors can increase the risk of diabetic ketoacidosis (DKA), even in the absence of high blood glucose. Monitor ketones if symptoms like nausea, vomiting, or abdominal pain develop, particularly in patients with type 1 diabetes or those with low-carbohydrate diets.

Key Instructions

  • Take one tablet (20 mg) once daily in the morning, ideally before your first meal.
  • Swallow the tablet whole with water—do not split, crush, or chew it.
  • Stay hydrated throughout the day. Bexagliflozin lowers blood sugar by increasing glucose excretion through urine, which can lead to fluid loss. Drinking plenty of water helps prevent dehydration and supports the medication's benefits.

Bloodwork Schedule

We recommend baseline labs before starting the protocol and a follow-up at 4 weeks after starting treatment to ensure the medication is working effectively and safely.

The follow-up bloodwork will include:

  1. Renal Function Tests: To monitor kidney health (eGFR, BUN, and Creatinine).
  2. Electrolyte Panel: Sodium, Potassium, and Magnesium levels.
  3. Lipid Profile: To assess cholesterol and triglycerides.
  4. Blood Glucose and HbA1c: To assess your metabolic response..
  5. Complete Blood Count (CBC): To check overall blood health.

Safety Notes

  • Avoid high-sugar meals, as they can amplify side effects like urinary tract infections or dehydration.
  • Notify our clinical team if you experience symptoms such as dizziness, excessive thirst, urinary discomfort (e.g., burning, frequent urination), or unusual infections, such as genital yeast infections or UTIs.
  • Inform us if you have any pre-existing conditions, such as kidney or liver issues, that may require additional monitoring.

Lifestyle Recommendations

While Bexagliflozin is a powerful tool to support your longevity goals, it’s not a substitute for a healthy lifestyle. A consistent exercise routine, balanced diet, and regular hydration will enhance the benefits of the protocol.

If you have any questions or concerns, please don’t hesitate to contact our clinical team. We’re here to support you throughout this process.