Generic Name

Talvey

Mechanism

• Selective blockade of renal SGLT2 receptors in the proximal convoluted tubule (≈ 70 % of glucose reabsorption).
• Inhibits glucose reabsorption → increased urinary glucose excretion (glucosuria) and lowered plasma glucose.
• Reduces insulin demand and improves insulin sensitivity.
• Indirect effects: modest diuresis, osmotic natriuresis, and lowering of arterial pressure.

Pharmacokinetics

*Data derived from phase III IMPROVE‑T2DM trial.

Indications

• Type 2 diabetes mellitus: monotherapy or add‑on to metformin, sulfonylureas, or insulin.
• Cardiovascular benefit: reduction in composite outcome of myocardial infarction, stroke, or cardiovascular death (≥ 18 % relative risk reduction).
• Heart failure: improves symptoms and decreases hospitalization in patients with HFrEF, irrespective of diabetes status.
• Albuminuria management: ↓ urinary albumin‑creatinine ratio in patients with diabetic kidney disease.

Contraindications

Contraindicated
• Type 1 diabetes mellitus or risk of diabetic ketoacidosis (DKA).
• Severe renal impairment (eGFR < 30 mL/min/1.73 m²) or end‑stage kidney disease.
• Pregnancy and lactation.

Warnings
• DKA – monitor ketones, educate patients.
• Genital mycotic infections – advise genital hygiene.
• Urinary tract infections – especially in women.
• Hypotension – due to osmotic diuresis; caution in patients with volume depletion.
• Renal function – decline in eGFR may occur; reassess every 3 months in patients with reduced baseline function.

Dosing

| Regimen | For: ‑

--
• | Initial | 25 mg once daily (or 12.5 mg in patients with eGFR 30–45 mL/min/1.73 m²).

| Maintenance/​Up­titration | 50 mg once daily (max 75 mg for eligible patients).

| Route | Oral, preferably with breakfast.

| With Meals | No strict requirement; consistency preferred.

| Missed Dose | Take as soon as remembered; skip if already close to next dose.

Adverse Effects

Serious
• Diabetic ketoacidosis (especially with insulin taper or short eating periods).
• Severe volume‐depletion leading to orthostatic hypotension or renal impairment.
• Rarely, necrotizing fasciitis of the genital area (rare SGLT2 inhibitor complication – consult FDA).

Monitoring

• HbA1c: baseline, 3 months, then every 6 months.
• eGFR and serum creatinine: baseline, 3 months, then every 6 months if stable; annually if CKD.
• Urine ketones: if symptoms of DKA or fasting.
• Blood pressure: at each visit.
• Weight: baseline, 3 months, then annually.

Clinical Pearls

• DKA Prevention: Educate patients that *even without weight loss or hypoglycaemia*, blood glucose can remain normal while ketones rise. Encourage regular ketone checks during illness or reduced carbohydrate intake.
• Weight Management: Talvey’s osmotic diuresis leads to ~2–3 kg of weight loss in the first month; add to existing lifestyle plan.
• Cardiovascular & Renal “Dual Protection”: In trials, Talvey lowered systolic BP by 3–5 mmHg and reduced albuminuria by 30 % – consider it first‑line in T2DM patients with ASCVD risk.
• Combination with Metformin: Start both at lower doses (25 mg Talvey + 500 mg metformin) to mitigate GI upset; titrate upward together.
• Pregnancy Counseling: Despite FDA pregnancy category B data, avoid use during pregnancy; withdraw promptly if pregnancy is suspected.
• Drug–Drug Interactions: Strong CYP3A4 inducers (e.g., rifampin) can lower Talvey exposure; careful dose adjustment or alternative therapy is advised.

Summary: Talvey combines glucose‑lowering efficacy with non‑hypoglycaemic safety, cardiovascular protection, and a favorable weight‑loss profile, making it a compelling option in contemporary T2DM management.