When it is necessary to decrease cerebral blood flow, MAP can be lowered using common antihypertensive agents such as calcium channel blockers.If there is an intact blood–brain barrier, osmotherapy (mannitol or hypertonic saline) may be used to decrease ICP.It is unclear whether mannitol or hypertonic saline is superior, or if they improve outcomes.Struggling, restlessness, and seizures can increase metabolic demands and oxygen consumption, as well as increasing blood pressure. Analgesia and sedation are used to reduce agitation and metabolic needs of the brain, but these medications may cause low blood pressure and other side effects. Thus if full sedation alone is ineffective, people may be paralyzed with drugs such as atracurium. Paralysis allows the cerebral veins to drain more easily, but can mask signs of seizures, and the drugs can have other harmful effects. Paralysing drugs are only introduced if patients are fully sedated (this is essentially the same as a general anaesthetic)

Surgery
Craniotomies are holes drilled in the skull with the help of cranial drills to remove intracranial hematomas or relieve pressure from parts of the brain. As raised ICPs may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICPs.A drastic treatment for increased ICP is decompressive craniectomy, in which a part of the skull is removed and the dura mater is expanded to allow the brain to swell without crushing it or causing herniation.
Cytochrome P450 enzymes play only a minor role in its metabolism.The elimination half-life is estimated to be 17 hours. 40.9% are eliminated via the feces (33.8% in unchanged form and 7.1% as metabolites) and 50.2% via the urine (1.5% unchanged and 48.7% as metabolites). The high proportion of unchanged substance in the feces is probably due to hydrolysis of the metabolites back to the parent substance. Society and culture
Legal status
Ertugliflozin, ertugliflozin/metformin, and ertugliflozin/sitagliptin were approved for medical use in the United States in December 2019, and in the European Union in March 2018. References
External links
"Ertugliflozin". Drug Information Portal. U.S. National Library of Medicine.