canagliflozin

Generic Name: canagliflozin (KAN a gli FLOE zin)
Brand Name: Invokana

What is canagliflozin?

Canagliflozin is an oral diabetes medicine that helps control blood sugar levels. Canagliflozin works by helping the kidneys get rid of glucose from your bloodstream.

Canagliflozin is used together with diet and exercise to treat type 2 diabetes. Canagliflozin is not for treating type 1 diabetes.

Canagliflozin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about canagliflozin?

You should not use canagliflozin if you have severe kidney disease, if you are on dialysis, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Canagliflozin is not for treating type 1 diabetes.

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What should I discuss with my healthcare provider before taking canagliflozin?

You should not use canagliflozin if you are allergic to it, or if you have:

  • kidney disease (or if you are on dialysis); or

  • if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

To make sure canagliflozin is safe for you, tell your doctor if you have:

  • kidney disease;

  • liver disease;

  • low blood pressure;

  • an electrolyte imbalance (such as high levels of potassium in your blood); or

  • high cholesterol levels.

FDA pregnancy category C. It is not known whether canagliflozin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether canagliflozin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Side effects may be more likely to occur in older adults.

Do not give this medication to anyone under 18 years old without medical advice.

How should I take canagliflozin?

Canagliflozin is usually taken once per day. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Canagliflozin works best if you take it before your first meal of the day.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

You may have very low blood pressure while taking this medication. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, pale skin, irritability, dizziness, feeling shaky, or trouble concentrating. Always keep a source of sugar with you in case you have low blood sugar. Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency.

If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your medication dose or schedule without your doctor's advice.

This medication can cause positive results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using canagliflozin.

Canagliflozin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking canagliflozin?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Canagliflozin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • pain or burning when you urinate;

  • signs of a genital infection (penis or vagina), such as pain, burning, itching, or discharge;

  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

  • swelling, rapid weight gain, little or no urinating; or

  • feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin.

Common side effects may include:

  • urinating more than usual;

  • nausea; or

  • constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Canagliflozin dosing information

Usual Adult Dose for Diabetes Type 2:

Initial dose: 100 mg orally once daily
Maximum dose: May increase to 300 mg orally once daily in patients with an eGFR of 60 mL/min/1.73m2 or greater, tolerating therapy with 100 mg, and requiring additional glycemic control

Comments:
-Do not initiate in patients with an eGFR less than 45 mL/min/1.73m2 as this drug will not be effective.
-If used in combination with insulin or an insulin secretagogue, a lower dose of insulin or the insulin secretagogue should be considered to reduce the risk of hypoglycemia.

Use: As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.

What other drugs will affect canagliflozin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with canagliflozin, especially:

  • digoxin, digitalis;

  • rifampin;

  • ritonavir;

  • a diuretic or "water pill";

  • heart or blood pressure medicine; or

  • seizure medication--phenobarbital, phenytoin.

This list is not complete. Other drugs may interact with canagliflozin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about canagliflozin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02. Revision Date: 2014-03-26, 4:09:01 PM.

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