Canagliflozin is an SGLT2 inhibitor for T2DM. Increased risk of amputation and fracture compared to other SGLT2 inhibitors.
Also known as: Invokana
SGLT2 + biguanide: potential for dehydration and lactic acidosis.
Metformin is renally excreted and requires eGFR >30 mL/min to prevent accumulation and lactic acidosis. Canagliflozin causes volume loss (glycosuria + osmotic diuresis) that may reduce eGFR and increase metformin levels. Particularly elevated risk in: (1) elderly, (2) patients with borderline eGFR (30-45), (3) concomitant diuretic use, (4) dehydration from acute illness. Strategy: check eGFR before and 3 months after starting SGLT2. Discontinue SGLT2 if dehydrated or eGFR <45.
SGLT2 + biguanide: risk of dehydration and lactic acidosis. Metformin requires adequate hydration. Monitor GFR and electrolytes.
Both affect fluid homeostasis. Metformin requires adequate hydration to prevent lactic acidosis.
Creatinine, electrolytes, hydration status
Lactic acidosis, severe dehydration
Monitor renal function and hydration status. Discontinue SGLT2 if dehydrated.
DailyMed/FDA (NIH/NLM) — approved Canagliflozin (Invokana) label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b9057d3b-b104-4f09-8a61-c61ef9d4a3f3
No documented food or drink interactions.
No documented disease interactions.
No documented pregnancy or breastfeeding information.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Inhibits SGLT2 (selective) and, to a lesser extent, SGLT1 (non-selective), blocking renal glucose reabsorption.
Blocks SGLT2 and SGLT1. SGLT1 inhibition in the intestine may contribute to gastrointestinal effects.
Oral bioavailability: ~65%. Food does not significantly affect absorption. Tmax: 1-2 hours.
Metabolised by UGT1A9 and UGT2B4 to glucuronide. Weak UGT1A9 inhibition. Minimal CYP metabolism.
10-13 hours. Elimination: ~60% urine (metabolites), ~33% faeces.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
