Warning of possible adverse effects of SGLT2i on horses.

© Brian Sedgbeer Dreamstime.com

A group of veterinary experts have issued a warning regarding the potential adverse effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in horses. In a letter published in the Veterinary Record, Bruce McGorum and clinicians from leading veterinary hospitals like the Royal (Dick) School of Veterinary Studies, Edinburgh, Rossdales Equine Hospital, the University of Liverpool, and the Royal Veterinary College expressed their concerns.

These medications, such as ertugliflozin and canagliflozin, are increasingly used to treat equine metabolic syndrome (EMS), particularly in horses with laminitis that hasn't responded to dietary adjustments. While these drugs have shown promise in reducing serum insulin concentrations, promoting weight loss, and managing laminitis related to hyperinsulinemia, concerns have been raised about significant adverse effects.

 

Minor side effects reported include increased serum triglycerides and liver enzymes, dullness, and increased drinking and urination. However, more serious cases have shown markedly elevated serum triglycerides (above 40 mmol/L), increased liver enzymes (such as GGT, GLDH, LDH), and bile acids, indicating potential liver damage or dysfunction. These biochemical changes were also accompanied by clinical signs such as dullness, loss of appetite, gastric impaction, bilateral laryngeal paralysis, hepatic encephalopathy, and, in some cases, death.

 

Due to these risks, the experts recommend that SGLT2 inhibitors be used only in horses that have not responded to adequate dietary or exercise management, or those with severe laminitis. 

 

Additionally, they advise against using these medications in horses with pre-existing liver disease or hyperlipaemia and emphasize the importance of regular monitoring of diet, liver enzymes, serum triglycerides, and bile acids. Horse owners should be educated about the signs of hyperlipaemia and the potential risks involved in the use of these drugs.

 

Further research is needed to fully understand the risk factors and adverse effects of SGLT2 inhibitors in horses. Until then, their use should be restricted to cases where other treatment options have failed.

For more details, see:

B C McGorum, J A Keen, S McCullagh, CM Marr, C MacKenzie, H Carslake, N Menzies-Gow, Bettina Dunkel, M Hewetson, J Reed, E Knowles.

Potential adverse effects of SGLT2i in horses 

Veterinary Record (2024) vol 195, 253