Canagliflozin

💊 What is Canagliflozin used for?

• •Helping to improve blood sugar (glucose) control in adults and children aged 10 and older with type 2 diabetes, along with diet and exercise
• •Reducing the risk of major heart events (heart-related death, non-fatal heart attack, and non-fatal stroke) in adults with type 2 diabetes and established cardiovascular disease
• •Reducing the risk of end-stage kidney disease, a doubling of serum creatinine, heart-related death, and hospitalization for heart failure in adults with type 2 diabetes and diabetic kidney disease (nephropathy) with a certain amount of protein in the urine

How it works

Canagliflozin blocks SGLT2, a protein in the kidneys that normally takes back most of the sugar (glucose) filtered by the kidney. Because of this, more glucose leaves the body in the urine.

How it is usually taken

• •The label says it is a tablet taken by mouth, once a day. For blood sugar control, it is taken before the first meal of the day. The label says the dose may be adjusted by the prescriber, and that the dose may need to change in people with kidney problems or who take certain other medicines. Follow the instructions from your prescriber or pharmacist.

Comes as

• •100 mg tablets: yellow, capsule-shaped, film-coated, marked "CFZ" on one side and "100" on the other
• •300 mg tablets: white, capsule-shaped, film-coated, marked "CFZ" on one side and "300" on the other

⚠️ Canagliflozin side effects

🛑 Who should not take Canagliflozin, and who should be careful

The label says not to take it if

• 🚨The label says it should not be used by people with a serious allergic reaction (such as anaphylaxis or angioedema) to canagliflozin or any ingredient in the tablet
• 🚨The label says it is not recommended for blood sugar control in people with type 1 diabetes
• 🚨The label says it is not recommended for blood sugar control in people with type 2 diabetes and an eGFR less than 30 mL/min/1.73 m², where it is likely to be ineffective

Tell your doctor before taking it if

• •Tell your healthcare provider about all of your medical conditions. The label says kidney function should be checked before starting, and any volume depletion (loss of body fluid) should be corrected first.
• •Tell your provider if you have a history of amputation, heart disease, blocked or narrowed blood vessels in the legs, nerve damage in the legs, or diabetic foot ulcers or sores.
• •Tell your provider if you have a history of pancreatitis or pancreatic surgery, as the label lists these as risk factors for ketoacidosis.
• •Ask your provider about ketone monitoring. The label says ketones may be checked in urine or blood, even if blood sugar is less than 250 mg/dL.
• •The label says the safety and effectiveness in children under 10 years of age are not known.
• •The label says the medicine is not recommended for blood sugar control in people with type 1 diabetes.

🔀 Canagliflozin with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Insulin or insulin secretagogues (such as sulfonylureas): the risk of low blood sugar (hypoglycemia) increases. The label says a lower dose of the insulin or secretagogue may be needed.
• •UGT enzyme inducers, such as rifampin, phenytoin, phenobarbital, and ritonavir: these can lower how well canagliflozin works. The label describes dose adjustments for these medicines.
• •Digoxin: canagliflozin increases digoxin levels, so the label says digoxin doses may need to be monitored and adjusted.
• •Lithium: an SGLT2 inhibitor may lower lithium levels, so the label says lithium levels should be checked more often when starting or changing the dose.
• •Water pills (diuretics) and other blood pressure medicines: these can raise the risk of dehydration, according to the Medication Guide.
• •Urine glucose tests and the 1,5-AG test: the label says these are not reliable for tracking blood sugar in people taking SGLT2 inhibitors, and other methods are recommended.

Alcohol and food

The label says drinking too much alcohol can raise the risk of ketoacidosis. Eating a very high-fat, low-carbohydrate (ketogenic) diet, eating much less than usual, and skipping meals are also listed as risk factors for ketoacidosis. The label says the tablet is taken before the first meal of the day for blood sugar control.

🤰 Canagliflozin in pregnancy and breastfeeding

Pregnancy

The label says it is not recommended during the second and third trimesters of pregnancy, based on animal studies showing kidney effects in young animals. The label also notes that poorly controlled diabetes in pregnancy carries risks for both mother and baby. Talk with your healthcare provider about your situation.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to keep the tablets out of reach of children. Store at 20 °C to 25 °C (68 °F to 77 °F). Short excursions between 15 °C and 30 °C (59 °F and 86 °F) are allowed.

If a dose is missed

The label does not say.

If too much is taken

The label says to contact the Poison Help line at 1-800-222-1222 or a medical toxicologist if an overdose happens. Supportive care is used as needed. The label states that about 4 hours of hemodialysis removed only a negligible amount of canagliflozin, and it is not expected to be removed by peritoneal dialysis.

🗒️ Questions to ask about Canagliflozin

• Am I at higher risk of ketoacidosis, and how should I check for ketones?
• Should my kidney function be checked before and during treatment?
• What can I do to prevent dehydration while taking this medicine?
• Should I check my feet regularly, given the label's warning about lower limb amputation?
• Could this medicine change how my other diabetes medicines or insulin work?
• What should I do if I get symptoms of a yeast infection or urinary tract infection?

❓ Canagliflozin: frequently asked questions