Vet Guide to Bexacat® (Bexagliflozin) in 2025 🐾

Hi, I’m Dr Duncan Houston BVSc, founder of Ask A Vet. In this detailed 2025 guide, we cover Bexacat®—the first **oral** diabetes medication for cats requiring no injections. Learn how it works, when to use it, proper dosing, potential side effects, safety protocols, and what to monitor. Let’s go! 🐱💉

📘 What Is Bexacat®?

Bexacat® (bexagliflozin) is a sodium-glucose co-transporter 2 (**SGLT2**) inhibitor—an oral tablet approved for feline diabetes. It lowers blood sugar by promoting glucose excretion in urine rather than stimulating insulin production :contentReference[oaicite:3]{index=3}.

✅ Ideal Candidates—Who Can Use It?

• Cats newly diagnosed with diabetes mellitus that are **otherwise healthy**, not dehydrated or anorexic :contentReference[oaicite:4]{index=4}.
• Cats weighing at least **6.6 lb (3 kg)** :contentReference[oaicite:5]{index=5}.
• **Not suitable** for cats previously treated with insulin or with insulin-dependent diabetes mellitus :contentReference[oaicite:6]{index=6}.
• Contraindicated if liver, kidney, pancreatic disease, anorexia, dehydration, or lethargy are present :contentReference[oaicite:7]{index=7}.

📐 Dosing & Administration

• **Standard dose**: 15 mg orally once daily, at the same time each day :contentReference[oaicite:8]{index=8}.
• Can be given **with or without food**, according to label guidance :contentReference[oaicite:9]{index=9}.
• Tablet comes flavored for palatability; monitor to ensure full ingestion.

🩺 Clinical Effectiveness

In clinical trials of newly diagnosed cats, **84%** achieved improved blood glucose control and better quality of life after 56 days of Bexacat® therapy :contentReference[oaicite:10]{index=10}. Many cats showed significant reductions in glucose and fructosamine levels, with sustained benefit through 124 days in extension studies :contentReference[oaicite:11]{index=11}.

⚖️ Advantages Over Insulin?

• **Needle-free** once-daily dosing—no injections required :contentReference[oaicite:12]{index=12}.
• Avoids insulin peaks and low glucose risks—especially attractive to owners wary of injections :contentReference[oaicite:13]{index=13}.
• May simplify management of stable, non-insulin-dependent diabetics.

⚠️ Safety & Side Effects

Common mild effects include:
• Vomiting, diarrhea, reduced appetite, dehydration, mild lethargy :contentReference[oaicite:14]{index=14}.
• Changes in urination and thirst are expected due to glucosuria :contentReference[oaicite:15]{index=15}.

**Serious risk**: diabetic ketoacidosis (**DKA**) or euglycemic DKA—even when blood sugar remains near normal. This may be life-threatening :contentReference[oaicite:16]{index=16}.

🛑 Recognize DKA/Euglycemic DKA

Watch for these signs (even if glucose is normal): lethargy, anorexia, dehydration, diarrhea, rapid breathing. Immediate vet evaluation is critical :contentReference[oaicite:17]{index=17}.

🔄 Monitoring & Follow-Up

• Baseline labs before starting: CBC, chem, urinalysis including ketones :contentReference[oaicite:18]{index=18}.
• Recheck within 1–2 weeks and every 4–6 weeks thereafter—focus on clinical signs, ketones, hydration :contentReference[oaicite:19]{index=19}.
• Monitor fructosamine or blood glucose curves to track control.
• Stop Bexacat® and consider insulin if poor control or DKA develops :contentReference[oaicite:20]{index=20}.

💡 Practical Treatment Plan

🐱 Newly Diagnosed, Well, ≥3 kg

• Start Bexacat® 15 mg once daily; check labs & ketones in 7–10 days.
• Manage mild effects (vomiting, thirst) by offering food, hydration.
• Reassess every 4–6 weeks; if good control and no ketones, continue.

⚠️ Signs of Concern

• If lethargy or reduced appetite—and especially ketones—stop Bexacat®, test for DKA & begin insulin as advised.
• Caution with cats having borderline kidney, liver disease—even subclinical issues.

❓ FAQs

Can Bexacat® replace insulin?

Yes, but only in healthy, newly diagnosed cats not requiring insulin. It's not for those already on insulin or with insulin-dependent diabetes :contentReference[oaicite:21]{index=21}.

Is it reversible if stopped?

Yes, but if DKA or ketoacidosis occurs, immediate insulin therapy and vet care are essential :contentReference[oaicite:22]{index=22}.

Why monitor ketones, not just glucose?

Euglycemic DKA can occur despite normal glucose; ketones reveal metabolic danger earlier :contentReference[oaicite:23]{index=23}.

Cost considerations?

The drug costs around $100–$150/month depending on provider :contentReference[oaicite:24]{index=24}—similar to insulin therapy overall.

📌 Final Takeaways

• Bexacat® is the only oral, once-daily SGLT2 inhibitor approved for feline diabetes in cats ≥3 kg who haven’t yet used insulin.
• 12–84% show improved glucose control and quality of life during trials :contentReference[oaicite:25]{index=25}.
• Ketoacidosis risk exists—even if glucose is normal—so careful screening and ongoing monitoring are crucial.
• Requires weekly follow-ups initially, then every 4–6 weeks; test ketones and labs routinely.
• If any signs of illness or ketones arise, discontinue and initiate insulin/emergency care.

Want help determining if Bexacat® is right for your cat—or need insulin-switch protocols? Download the Ask A Vet app for personalized vet support 24/7. Your cat deserves the best, easier care! 🐾❤️