SGLT2 inhibitors and Fournier's gangrene

Last edited 03/2019 and last reviewed 07/2021

SGLT2 inhibitors: reports of Fournier's gangrene (necrotising fasciitis of the genitalia or perineum)

• if Fournier's gangrene is suspected, stop the SGLT2 inhibitor and start treatment urgently (including antibiotics and surgical debridement). Fournier's gangrene is a rare but potentially life-threatening infection that requires urgent medical attention

Advice for healthcare professionals:

• post-marketing cases of Fournier's gangrene (necrotising fasciitis of the genitalia or perineum) have been associated with the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors
  
  
• Fournier's gangrene is a rare but serious and potentially life-threatening infection
  
  
• if Fournier's gangrene is suspected, stop the SGLT2 inhibitor and urgently start treatment (including antibiotics and surgical debridement as required)
  • patients taking SGLT2 inhibitors should be advised to seek urgent medical attention if they experience severe pain, tenderness, erythema, or swelling in the genital or perineal area accompanied by fever or malaise
    
    
• urogenital infection or perineal abscess may precede necrotising fasciitis
  
  
• advise patients to seek urgent medical attention if they experience severe pain, tenderness, erythema, or swelling in the genital or perineal area, accompanied by fever or malaise
  
  
• report suspected adverse drug reactions to a SGLT2 inhibitor to the Yellow Card Scheme without delay

Reference:

• MRHA (February 2019). Drug Safety Update 12(7):1-8.