Antidiabetic Agent; Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor
“ALERT: US Boxed Warning
Lower limb amputation:
An increased risk of lower limb amputations associated with canagliflozin use versus placebo was observed in CANVAS (5.9 vs 2.8 events per 1,000 patient-years) and CANVAS-R (7.5 vs 4.2 events per 1,000 patient-years), 2 large, randomized, placebo-controlled trials in patients with type 2 diabetes who had established cardiovascular disease or were at risk for cardiovascular disease. Amputations of the toe and midfoot were most frequent; however, amputations involving the leg were also observed. Some patients had multiple amputations, some involving both limbs. Before initiating, consider factors that may increase the risk of amputation, such as a history of prior amputation, peripheral vascular disease, neuropathy, and diabetic foot ulcers. Monitor patients receiving canagliflozin for infection, new pain or tenderness, sores or ulcers involving the lower limbs, and discontinue if these complications occur.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does it Work
SGLT2 is in the proximal renal tubules of the nephron (a functional unit of the kidney) and is the main site of the reabsorption of filtered glucose. Canagliflozin, Invokana inhibits this transporter which lowers glucose reabsorption and lowers the renal threshold for glucose resulting in its urinary excretion thereby lowering plasma glucose concentrations.
Indications For Use
Canagliflozin, Invokana is indicated for Diabetes mellitus type 2.
Before starting Canagliflozin, Invokana makes sure your physician is aware of any allergies, medications you currently take, if you have kidney disease, a history of diabetic ketoacidosis, have had bariatric surgery, are pregnant or breastfeeding.
100-300mg once daily
Pharmacist Tips On Using
How to Take Canagliflozin, Invokana: Follow instructions provided by physician/pharmacy label, take consistently at the same time each day usually in the morning due to diuretic effect unless otherwise directed, ideally 30 minutes prior to a first meal to prevent postprandial hyperglycemia due to delayed absorption, store at room temperature. Monitor blood pressure when initiating due to diuretic effect.
You Need to Avoid: Do not skip a standard diabetic foot care regimen. Must monitor for wounds or signs of a new infection, ulcers, sores or new pain or tenderness. Avoid volume depletion or dehydration due to the diuretic effect of this medication.
Urinary tract infection (due to sugar content in urine – more common in females due to shorter urethra), increased urine output, genitourinary fungal infection (more common in females), nausea, thirst, hypotension.
(Note this is not a complete list of side effects only common ones)
Frequently Asked Questions
What is hypoglycemia?
Hypoglycemia is a condition of low blood sugar (>3.9mmol/L-Canada; 70mg/dL-US) which is considered a medical emergency whereas hyperglycemia is a slow progressive condition. It generally occurs with irregularities in diet, exercise, and medications in diabetic patients. It is preferably treated with simple sugars such as dextrose; regular table sugar can work but is slower acting as it needs to be digested and if blood sugar is extremely low this delay can be a problem. Hypoglycemia has a large host of progressive symptoms from hunger, headache, nausea, sweating, palpitations, mood swings, irritability to seizure, coma and in severe cases, death.