canagliflozin

Adult Dosing

Type 2 diabetes mellitus

Start 100 mg PO qday taken before the first meal of the day
May increase up to 300 mg/day in patients tolerating 100 mg/day who have an eGFR = > 60 mL/min/1.73 m² and require additional glycemic control

Pediatric Dosing

Safety and efficacy have not been established in the pediatric population

[Outline]

Adult Dosing
Pediatric Dosing

Indications ⬆ ⬇

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Contraindications ⬆ ⬇

Hypersensitivity to any of the ingredients of the product
Severe renal impairment, ESRD, or patients on dialysis
Type 1 diabetes mellitus
Diabetic ketoacidosis

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Mild renal impairment (eGFR = > 60 mL/min/1.73 m ²): No dose adjustments
Moderate renal impairment (eGFR 45 to < 60 mL/min/1.73 m ²): Max: 100 mg/day
eGFR <45 mL/min/1.73 m ²): Do not initiate canagliflozin
Severe renal impairment, ESRD, or patients on dialysis: Use is contraindicated

Hepatic Dose Adjustment

Mild-moderate impairment: No dose adjustments
Severe impairment: Not recommended

Warnings/Precautions ⬆ ⬇

Therapy may cause intravascular volume contraction and symptomatic hypotension particularly in patients with impaired renal function (eGFR < 60 mL/min/1.73 m²), elderly patients, patients on either diuretics or medications that interfere with the renin-angiotensin-aldosterone system (e.g., angiotensinconverting-enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs]), or patients with low systolic blood pressure. Closely monitor patients and assess volume status before and regularly after initiating therapy
Drug increases serum creatinine and decreases eGFR, patients with hypovolemia are more susceptible to renal function impairment. Frequent renal function monitoring is recommended in patients with an eGFR < 60 mL/min/1.73 m²
Therapy may lead to hyperkalemia; patients with moderate renal impairment who take potassium-sparing diuretics or drugs that alter the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia. Monitor serum potassium levels periodically
Therapy may increase the risk of hypoglycemia with insulin and insulin secretagogues, a lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination
Genital mycotic infections may occur, uncircumcised males and patients with history of genital mycotic infections are more susceptible. Monitor closely and treat appropriately
Hypersensitivity reactions (eg, generalized urticaria), some serious, were reported with use of canagliflozin. Treat as per standard of care and monitor until signs and symptoms resolve
Dose-related increases in LDL-C have been reported. Monitor LDL-C and treat per standard of care after initiating therapy

Interactions ⬆ ⬇

Invokana interacts with :

	Lanoxicaps
	Lanoxin
	Lanoxin pediatric

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:C

Breastfeeding: Safety unknown; as many drugs are excreted in breast milk and because of the potential for serious adverse reactions in nursing infants, manufacturer advises to make a decision whether to discontinue nursing while taking the drug or to discontinue therapy, taking into account the importance of the drug to the mother.

Adverse Reactions ⬆ ⬇

CV: Hypotension
GI: Constipation, nausea
METABOLISM: Hyperkalemia, hypoglycemia
GU: Urinary tract infections, genital mycotic infections, increased urination, vulvovaginal pruritus
MISC: Hypersensitivity reactions
LAB TESTS: Increases in low-density lipoprotein (LDL-C)

Clinical Pharmacology ⬆ ⬇

Selective sodium-glucose transporter-2 (SGLT2) inhibitor; lowers the renal glucose threshold by reducing reabsorption of filtered glucose thereby increasing urinary glucose excretion
Bioavailability: 65%
Metabolism: Majorly undergoes o-glucuronidation, mainly by UGT1A9 and UGT2B4 to 2 inactive metabolites
Excretion: Feces: (41.5%); Urine: (33%) mainly as o-glucuronide metabolites

Brands and Availability ⬆ ⬇