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

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

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

• N/A

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

• 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

Invokana interacts with :

	Lanoxicaps
	Lanoxin
	Lanoxin pediatric

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.

• 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)

• 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

US Trade Name(s)

• Invokana

US Availability

Invokana

• TABS: 100, 300 mg

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Endocrine/Metabolic

Antidiabetic Agents

Selective Sodium-glucose Transporter-2 (SGLT2) Inhibitor