Canagliflozin

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Canagliflozin
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alberto Plate [2]

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Overview

Canagliflozin is a Endocrine-Metabolic Agent and Sodium Glucose Co-Transporter 2 Inhibitor that is FDA approved for the treatment of diabetes mellitus type 2. Common adverse reactions include Micturition frequency and polyuria, Urinary tract infectious disease, Mycosis of the Female genital.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

There is limited information regarding Canagliflozin FDA-Labeled Indications and Dosage (Adult) in the drug label.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Canagliflozin in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Canagliflozin in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Canagliflozin FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Canagliflozin in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Canagliflozin in pediatric patients.

Contraindications

There is limited information regarding Canagliflozin Contraindications in the drug label.

Warnings

Hypotension

INVOKANA causes intravascular volume contraction. Symptomatic hypotension can occur after initiating INVOKANA, particularly in patients with impaired renal function (eGFR less than 60 mL/min/1.73 m2), elderly patients, patients on either diuretics or medications that interfere with the renin-angiotensin-aldosterone system (e.g., angiotensin-converting-enzyme ACE inhibitors, angiotensin receptor blockers ARBs), or patients with low systolic blood pressure. Before initiating INVOKANA in patients with one or more of these characteristics, volume status should be assessed and corrected. Monitor for signs and symptoms after initiating therapy.

Impairment in Renal Function

INVOKANA increases serum creatinine and decreases eGFR. Patients with hypovolemia may be more susceptible to these changes. Renal function abnormalities can occur after initiating INVOKANA. More frequent renal function monitoring is recommended in patients with an eGFR below 60 mL/min/1.73 m2.

Hyperkalemia

INVOKANA can lead to hyperkalemia. Patients with moderate renal impairment who are taking medications that interfere with potassium excretion, such as potassium-sparing diuretics, or medications that interfere with the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia.

Monitor serum potassium levels periodically after initiating INVOKANA in patients with impaired renal function and in patients predisposed to hyperkalemia due to medications or other medical conditions.

Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues

Insulin and insulin secretagogues are known to cause hypoglycemia. INVOKANA can increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue. Therefore, a lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with INVOKANA.

Genital Mycotic Infections

INVOKANA increases the risk of genital mycotic infections. Patients with a history of genital mycotic infections and uncircumcised males were more likely to develop genital mycotic infections. Monitor and treat appropriately.

5.6 Hypersensitivity Reactions

Hypersensitivity reactions (e.g., generalized urticaria), some serious, were reported with INVOKANA treatment; these reactions generally occurred within hours to days after initiating INVOKANA. If hypersensitivity reactions occur, discontinue use of INVOKANA; treat per standard of care and monitor until signs and symptoms resolve [see CONTRAINDICATIONS (4) and ADVERSE REACTIONS (6.1)].

5.7 Increases in Low-Density Lipoprotein (LDL-C) Dose-related increases in LDL-C occur with INVOKANA [see ADVERSE REACTIONS (6.1)]. Monitor LDL-C and treat per standard of care after initiating INVOKANA.

5.8 Macrovascular Outcomes There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with INVOKANA or any other antidiabetic drug.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Canagliflozin Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Canagliflozin Postmarketing Experience in the drug label.

Drug Interactions

UGT Enzyme Inducers

Rifampin: Co-administration of canagliflozin with rifampin, a nonselective inducer of several UGT enzymes, including UGT1A9, UGT2B4, decreased canagliflozin area under the curve (AUC) by 51%. This decrease in exposure to canagliflozin may decrease efficacy. If an inducer of these UGTs (e.g., rifampin, phenytoin, phenobarbital, ritonavir) must be co-administered with INVOKANA (canagliflozin), consider increasing the dose to 300 mg once daily if patients are currently tolerating INVOKANA 100 mg once daily, have an eGFR greater than 60 mL/min/1.73 m2, and require additional glycemic control. Consider other antihyperglycemic therapy in patients with an eGFR of 45 to less than 60 mL/min/1.73 m2 receiving concurrent therapy with a UGT inducer and require additional glycemic control.

Digoxin

There was an increase in the AUC and mean peak drug concentration (Cmax) of digoxin (20% and 36%, respectively) when co-administered with INVOKANA 300 mg. Patients taking INVOKANA with concomitant digoxin should be monitored appropriately.

Positive Urine Glucose Test

Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors as SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests. Use alternative methods to monitor glycemic control.

Interference with 1,5-anhydroglucitol (1,5-AG) Assay

Monitoring glycemic control with 1,5-AG assay is not recommended as measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Canagliflozin in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Canagliflozin in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Canagliflozin during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Canagliflozin in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Canagliflozin in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Canagliflozin in geriatric settings.

Gender

There is no FDA guidance on the use of Canagliflozin with respect to specific gender populations.

Race

There is no FDA guidance on the use of Canagliflozin with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Canagliflozin in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Canagliflozin in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Canagliflozin in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Canagliflozin in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Canagliflozin Administration in the drug label.

Monitoring

There is limited information regarding Canagliflozin Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Canagliflozin and IV administrations.

Overdosage

There is limited information regarding Canagliflozin overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Canagliflozin Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Canagliflozin Mechanism of Action in the drug label.

Structure

There is limited information regarding Canagliflozin Structure in the drug label.

Pharmacodynamics

There is limited information regarding Canagliflozin Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Canagliflozin Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Canagliflozin Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Canagliflozin Clinical Studies in the drug label.

How Supplied

There is limited information regarding Canagliflozin How Supplied in the drug label.

Storage

There is limited information regarding Canagliflozin Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Canagliflozin Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Canagliflozin interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Canagliflozin Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Canagliflozin Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.