{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:27:53Z","timestamp":1785558473982,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sodium glucose co\u2010transporter 2 inhibitors (SGLT2is) are used to prevent cardiovascular complications in type 2 diabetes mellitus (T2DM) and newly indicated to treat heart failure (HF). Loop diuretics are commonly prescribed to manage volume overload in HF and may increase the risk of volume depletion in real\u2010world practice. This study evaluated the risk of volume depletion following concomitant use of SGLT2is and loop diuretics in veterans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Veterans with T2DM were included if they received concomitant loop diuretics and SGLT2is and experienced at least one volume depletion event between December 2012 and December 2019, utilizing a self\u2010controlled case series design. Concomitant prescribing periods were divided into focal windows of 1 to 14\u2009days, 14 to 28\u2009days, and greater than 28\u2009days. Incidence rate ratios (IRR) were estimated using multivariable Poisson regressions adjusted for age and renal function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>3352 patients experienced at least one volume depletion event and were concomitantly prescribed SGLT2is and loop diuretics at least once. The risk of volume depletion increased in the treatment versus control windows during the 1 to 14\u2010day window (IRR\u00a0=\u00a01.82, 95% CI 1.63\u20132.02) the 15\u2010to\u201028\u2010day window (IRR\u00a0=\u00a01.46, 95% CI 1.28\u20131.67), and the greater than 28\u2010day window (IRR\u00a0=\u00a01.22, 95% CI 1.21\u20131.34).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Concomitant prescribing of SGLT2is and loop diuretics is associated with an increased risk of volume depletion, an effect that attenuates with longer therapy durations. Prescribers need to closely monitor fluid status in patients receiving concomitant therapy, especially those with advancing age or with eGFR below 60.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5496","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T11:10:39Z","timestamp":1655464239000},"page":"1102-1109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk of volume depletion events with concomitant use of sodium glucose co\u2010transporter 2 inhibitors and loop diuretics: A self\u2010controlled case series study"],"prefix":"10.1002","volume":"31","author":[{"given":"Colleen M.","family":"Lewellyan","sequence":"first","affiliation":[{"name":"Kansas City VA Medical Center  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Spoutz","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs VISN #20 VA Northwest Health Network  Vancouver Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs VISN #15 VA Heartland Network  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2600-6887","authenticated-orcid":false,"given":"Mark E.","family":"Patterson","sequence":"additional","affiliation":[{"name":"University of Missouri\u2010Kansas City School of Pharmacy  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504720"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1812389"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2004967"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2022190"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.022"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13309"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2016.08.008"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.120.045691"},{"key":"e_1_2_10_11_1","unstructured":"Farxiga\u00ae (dapagliflozin)Full prescribing information. AstraZeneca Pharmaceuticals LP Wilmington; 2021."},{"key":"e_1_2_10_12_1","unstructured":"Jardiance\u00ae (empagliflozin).Full prescribing information. Ingelheim Germany: Boehringer Ingelheim International GmbH Boehringer Ingelheim Pharmaceuticals Inc.; 2020."},{"key":"e_1_2_10_13_1","unstructured":"Invokana\u00ae (canagliflozin).Full prescribing information. Beerse Belgium: Janssen Pharmaceuticals Inc.; 2020."},{"key":"e_1_2_10_14_1","unstructured":"SteglatroTM (ertugliflozin).Full prescribing information. Whitehouse Station NJ USA: Merck & Co. 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