Usual Adult Dose for Diabetes Type 2

Initial dose: 100 mg orally once a day

• May increase to 300 mg orally once a day for additional glycemic control in patients who have tolerated therapy and who have an eGFR of 60 mL/min/1.73 m2 or greater

• Assess renal function before initiating therapy; consult renal dose adjustments for patients with an eGFR less than 60 mL/min/1.73 m2.
• Normalize volume status before initiating therapy.
• 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.

• As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.
• To reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease.
• To reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria greater than 300 mg/day.

Usual Adult Dose for Cardiovascular Risk Reduction

Initial dose: 100 mg orally once a day

• May increase to 300 mg orally once a day for additional glycemic control in patients who have tolerated therapy and who have an eGFR of 60 mL/min/1.73 m2 or greater

• Assess renal function before initiating therapy; consult renal dose adjustments for patients with an eGFR less than 60 mL/min/1.73 m2.
• Normalize volume status before initiating therapy.
• 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.

• As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.
• To reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease.
• To reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria greater than 300 mg/day.

Renal Dose Adjustments

eGFR of 60 mL/min/1.73 m2 or greater: No adjustment recommended
eGFR 30 to less than 60 mL/min/1.73 m2: Maximum dose: 100 mg orally once a day
eGFR less than 30 mL/min/1.73 m2: Initiation is not recommended to improve glycemic control as it is likely to be ineffective
eGFR less than 30 mL/min/1.73 m2 with albuminuria greater than 300 mg/day: Initiation is not recommended; however, may continue at 100 mg orally once a day to reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure
eGFR less than 30 mL/min/1.73 m2 with albuminuria 300 mg/day or less: Not recommended
ESRD on dialysis: Use is contraindicated

Concomitant Use With Uridine 5-diphospho (UDP)-glucuronosyl transferase (UGT) Enzyme Inducers: See Dosage Adjustments

Liver Dose Adjustments

Mild to moderate liver dysfunction: No adjustment recommended
Severe liver dysfunction: Not recommended

Dose Adjustments

Concomitant Use of Insulin and Insulin Secretagogues:

• A lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycemia.

• eGFR greater than 60 mL/min/1.73 m2: Increase canagliflozin to 200 mg/day in patients tolerating 100 mg/day; in patients requiring additional glycemic control, dose may be increased to 300 mg once a day
• eGFR less than 60 mL/min/1.73 m2: Increase canagliflozin to 200 mg/day in patients tolerating 100 mg/day; consider adding an alternative antihyperglycemic agent in patients requiring additional glycemic control

Precautions

CONTRAINDICATIONS:

• Serious hypersensitivity reaction to active substance such as anaphylaxis or angioedema
• Dialysis

Dialysis

Contraindicated

Other Comments

Administration advice:

• Take orally before the first meal of the day; swallow whole
• If a dose is missed, it should be taken as soon as it is remembered; however, double dosing to make up for a missed dose is not recommended

• Correct volume depletion prior to initiating treatment.
• Not recommended for patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.

• Assess fluid status prior to initiation and monitor for signs and symptoms of volume depletion during therapy
• Verify renal function at baseline, and monitor periodically during therapy
• Evaluate for the presence of acidosis, including ketoacidosis in symptomatic patients even if their blood sugar is not elevated
• Monitor legs and feet for any new pain, tenderness, sores, ulcers, or infections

• Read the US FDA-approved patient labeling (Medication Guide).
• Patients experiencing symptoms of ketoacidosis such as difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue, or sleepiness should be instructed to check for ketones even if their blood sugar is not elevated; patients should be instructed to stop taking this drug and seek immediate medical attention if symptoms of ketoacidosis occur.
• This drug will cause the urine to test positive for glucose.
• Ensure adequate fluid intake to avoid adverse reactions related to volume depletion such as orthostatic hypotension.
• Seek medical advice during periods of stress as medical management of glycemic control may change.
• Inform patients that genital mycotic infections, urinary tract infections, and hypersensitivity reactions may occur; patients should be instructed to contact their health care professional.
• Patients should be instructed to seek immediate medical attention for symptoms of tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, especially if they have a fever and are feeling unwell.
• Patients should be advised that this drug may increase their risk of lower limb amputations and should be instructed to report any new pain, tenderness, sores, ulcers, or infections of legs or feet.
• Patients should be instructed to seek medical attention promptly for signs and symptoms of acute kidney injury such as decreased urine, swelling in the legs or feet.

Frequently asked questions

• Is Invokana the same as metformin?
• How effective Is Invokana?