Formulary
Canagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
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Canagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
Drug action
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
Indications and dose
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate),Type 2 diabetes mellitus in combination with insulin or other antidiabetic drugs (if existing treatment fails to achieve adequate glycaemic control)**
- **Adult** (By Mouth): 100 mg once daily; increased if tolerated to 300 mg once daily if required, dose to be taken preferably before breakfast.
Cautions
Elderly (risk of volume depletion); elevated haematocrit; hypotension; risk of volume depletion Cautions, further information Volume depletion Correct hypovolaemia before starting treatment.
Contraindications
Diabetic ketoacidosis; type 1 diabetes mellitus (increased risk of diabetic ketoacidosis)
Side effects
Common or very common Balanoposthitis; constipation; dyslipidaemia; hypoglycaemia (in combination with insulin or sulfonylurea); increased risk of infection; nausea; thirst; urinary disorders; urosepsis Uncommon Dehydration; dizziness postural; hypotension; lower limb amputations; renal failure; skin reactions; syncope Rare or very rare Anaphylactic reaction; angioedema; diabetic ketoacidosis (discontinue immediately) Frequency not known Fournier's gangrene (discontinue and initiate treatment promptly) Side-effects, further information Consider interrupting treatment if volume depletion occurs.
Interactions
**Other interactions (3):**
- Combinations requiring caution Combinations which can increase the effects of digoxin when co-administered: amiodarone, canagliflozin, daclatasvir, flibanserin, flecainide, prazosin, propafenone,...
- Antidiabetics metformin (1 000 mg SD, doravirine 100 mg QD) metformin AUC 0.94 (0.88, 1.00) C max 0.94 (0.86, 1.03) No dose adjustment is required.
- Expected: canagliflozin liraglutide sitagliptin No dose adjustment is required.
Pregnancy
Avoid-toxicity in animal studies.
Breast feeding
Avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises avoid in severe impairment-no information available.
Renal impairment
Caution if eGFR less than 60 mL/minute/1.73 m 2 . M Avoid initiation when baseline eGFR less than 30 mL/minute/1.73 m 2 . M Dose adjustments Limit dose to 100 mg once daily when eGFR less than 60 mL/minute/1.73 m 2 ; consider addition of other hypoglycaemic agents if further glycaemic control needed. If eGFR falls to less than 30 mL/minute/1.73 m 2 during treatment, continue with 100 mg once daily. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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