TM Owner Merck & Co.
Segluromet 2.5mg/1000mg Tablet
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Indications & Clinical Uses
- Segluromet 2.5 mg/1000 mg is a film-coated tablet from Merck combining ertugliflozin, an SGLT2 inhibitor, with metformin hydrochloride, a biguanide, in one dose.
- It is approved as an adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus, either as an add-on when metformin or ertugliflozin alone is not enough, or for patients already taking both components separately who are switched to the fixed-dose tablet for convenience.
- It is not indicated for type 1 diabetes or diabetic ketoacidosis, and is not recommended in patients with significant kidney impairment.
- Segluromet is also marketed in the European Union under the same brand name.
- It is a self-administered oral tablet, taken twice daily with meals to reduce stomach upset, and is not a rescue treatment for high or low blood sugar emergencies.
Side Effects
- Segluromet carries a boxed warning for metformin-associated lactic acidosis, a rare but serious and sometimes fatal build-up of lactic acid in the blood; risk factors include kidney impairment, age 65 or over, dehydration, excess alcohol, liver disease, and conditions causing low oxygen in the body, and it requires immediate medical attention if suspected.
- The most common reactions, each affecting 5% or more of patients, are genital yeast infections in women from the ertugliflozin component, and diarrhoea, nausea, vomiting, flatulence, abdominal discomfort, indigestion, weakness and headache from the metformin component.
- Seek urgent care for signs of dehydration, a urinary infection that has spread to the kidney, or genital swelling, pain and fever, which can rarely signal a severe soft-tissue infection.
- Report unusual tiredness, muscle pain, or difficulty breathing straight away, as these can be early signs of lactic acidosis.
Precautions & Warnings
- Segluromet is contraindicated in severe kidney impairment (eGFR below 30 mL/min/1.73m2), end-stage kidney disease or dialysis, and in any type of metabolic acidosis, including diabetic ketoacidosis.
- Kidney function is checked before starting treatment and at least yearly afterward.
- Stop Segluromet temporarily before surgery or a procedure using injected iodine-containing contrast dye, and restart only once kidney function is confirmed stable, because both circumstances raise the risk of lactic acidosis and acute kidney injury.
- Diabetic ketoacidosis has occurred with SGLT2 inhibitors even when blood sugar readings looked only mildly raised, particularly after illness, surgery, very low food or fluid intake, or a very low-carbohydrate diet; seek medical advice for unexplained nausea, vomiting or breathing changes even with a normal glucose reading.
- Check feet regularly, since lower-limb amputation risk is a recognised class effect of SGLT2 inhibitors.
- Alcohol should be limited, since it raises lactic acidosis and low blood sugar risk.
Avoid Interactions
- Tell your healthcare provider about every medicine and supplement you take.
- Topiramate and other carbonic anhydrase inhibitors increase the risk of metabolic and lactic acidosis when combined with the metformin component of Segluromet.
- Drugs that reduce kidney clearance of metformin can raise metformin levels and toxicity risk, so doses may need adjusting.
- Insulin and insulin-releasing medicines such as sulfonylureas increase the risk of low blood sugar when combined with Segluromet, and a lower dose of the other medicine may be needed.
- Diuretics can add to volume depletion caused by the ertugliflozin component.
- Iodinated contrast media used for imaging can temporarily worsen kidney function, so Segluromet is usually paused around the time of the procedure.
- Alcohol increases the risk of lactic acidosis and should be limited.
References
Frequently Asked Questions
Segluromet (ertugliflozin/metformin) 2.5 mg/1000 mg is a combination tablet that improves blood sugar control in adults with type 2 diabetes, alongside diet and exercise. It combines an SGLT2 inhibitor with metformin in one pill. It is not used for type 1 diabetes or diabetic ketoacidosis, and is not a rescue treatment for a diabetic emergency.
Take Segluromet by mouth twice daily with meals, to lower the chance of stomach upset. Swallow the tablet whole; do not split or crush it. Your healthcare provider chooses your strength based on your current ertugliflozin and metformin doses, and may adjust it over time depending on blood sugar control.
The most common effects are genital yeast infections, diarrhoea, nausea, vomiting and stomach upset. Segluromet carries a boxed warning for metformin-associated lactic acidosis, a rare but serious build-up of acid in the blood causing tiredness, muscle pain and breathing difficulty. Get urgent medical help for these symptoms or for fever with genital pain.
Limit alcohol, which increases the risk of lactic acidosis and low blood sugar. Tell your healthcare provider about topiramate and other carbonic anhydrase inhibitors, and about any planned surgery or contrast-dye scan, since Segluromet is usually paused around these because of acidosis and kidney risk.
Your healthcare provider checks kidney function before starting Segluromet and at least once a year afterward, since both ingredients depend on healthy kidneys. Vitamin B12 levels may also be checked periodically, because long-term metformin use can lower them. Report unusual tiredness, muscle pain or breathlessness right away.
Segluromet is not recommended in pregnancy; insulin is generally preferred to control blood sugar, and effects on a developing baby have not been fully established. It is also contraindicated in severe kidney impairment, end-stage kidney disease or dialysis. Discuss family planning and any kidney problems with your healthcare provider first.
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