Whenever there is a black box warning on a medication, we have a natural hesitation to use in certain patients. Sometimes these warnings have real consequences, and sometimes they may be related to effects from another older drug in the same class. This was certainly the case with the biguanides, metformin and phenformin. Lactic acidosis was so common with phenformin that it was withdrawn from the market in 1957. Because of this fear, metformin, although available in Europe in 1956, was not approved in the U.S. till 1995.
Now we have a newer class of drugs that carry a warning that does not seem to be warranted. This month in our SGLT-2 inhibitor newsletter, we have some “evidence-based” information and statistics that may make you more likely to prescribe these medications in both type 1 and type 2 patients. Check out what Dr. Stanley Schwartz has to say about this new thinking on SGLT-2 use.