Why is this medication prescribed?

Canagliflozin is prescribed primarily to manage type 2 diabetes mellitus. It is an oral medication belonging to the class of sodium-glucose cotransporter 2 (SGLT2) inhibitors. Here are the key reasons why it is prescribed:

• Lowering Blood Sugar Levels: Canagliflozin helps lower blood sugar levels by inhibiting SGLT2 in the kidneys. This mechanism prevents the reabsorption of glucose back into the bloodstream, leading to increased glucose excretion in the urine.
• Adjunct to Diet and Exercise: It is typically prescribed when lifestyle changes (such as diet and exercise) alone are not sufficient to achieve adequate glycemic control in people with type 2 diabetes.
• Cardiovascular Benefits: Canagliflozin has shown cardiovascular benefits, including reducing the risk of heart attacks, strokes, and cardiovascular-related deaths in people with type 2 diabetes who are at high risk for these conditions.
• Weight Management: It may also contribute to modest weight loss due to the loss of calories through the excretion of glucose in the urine.
• Kidney Protection: SGLT2 inhibitors like canagliflozin have demonstrated protective effects on the kidneys, potentially slowing the progression of diabetic kidney disease.

How should this medicine be used?

Canagliflozin is available in tablet form and is typically taken orally once daily. The dosage and timing should be prescribed by a healthcare provider based on individual health factors, including kidney function and other medications being taken.

Here are some general guidelines for using canagliflozin:

• Dosage: The typical starting dose of canagliflozin is 100 mg once daily, taken in the morning before breakfast. Depending on how well blood sugar levels are controlled and tolerability, the dose can be increased to 300 mg once daily.
• Administration: Canagliflozin tablets should be taken whole with water and can be taken with or without food.
• Kidney Function: It is important to assess kidney function before starting canagliflozin and periodically thereafter. The dosage may need adjustment in individuals with impaired kidney function.
• Monitoring: Regular monitoring of blood sugar levels and kidney function is recommended while taking canagliflozin.
• Adherence to Lifestyle Changes: Canagliflozin should be used in conjunction with a healthy diet and regular exercise as prescribed by a healthcare provider.
• Potential Side Effects: Common side effects may include genital yeast infections, urinary tract infections, and increased urination. Rare but serious side effects include ketoacidosis (high levels of acids called ketones in the blood), serious urinary tract infections, and low blood sugar when used with insulin or other diabetes medications.

It’s essential to follow your healthcare provider’s instructions precisely regarding the use of canagliflozin and to report any concerns or unusual symptoms promptly.

Other uses for this medicine

• Heart Failure: There is ongoing research exploring the use of SGLT2 inhibitors, including canagliflozin, in treating heart failure. Some studies have shown benefits in reducing hospitalizations due to heart failure and improving outcomes in patients with both diabetes and heart failure.
• Non-alcoholic Fatty Liver Disease (NAFLD): Canagliflozin may have potential benefits in improving liver function and reducing liver fat accumulation in patients with NAFLD. Research in this area is still emerging.

What special precautions should I follow?

When using canagliflozin, it’s important to follow specific precautions to ensure safe and effective use:

• Kidney Function Monitoring: Canagliflozin is excreted through the kidneys. Therefore, it should not be used in patients with severe kidney impairment (eGFR less than 30 mL/min/1.73 m²) and caution is advised in those with moderate impairment (eGFR 30-60 mL/min/1.73 m²). Regular monitoring of kidney function is recommended before starting treatment and periodically thereafter.
• Dehydration and Hypotension: Canagliflozin can lead to increased urination and potential dehydration, especially in elderly patients and those taking diuretics. Patients should be advised to drink plenty of fluids to maintain hydration.
• Genital and Urinary Tract Infections: Canagliflozin may increase the risk of genital yeast infections (such as vaginal yeast infections and balanitis in men) and urinary tract infections. Patients should be educated on the signs and symptoms of these infections and seek medical advice if they occur.
• Hypoglycemia (Low Blood Sugar): When used with insulin or other diabetes medications that can cause hypoglycemia, canagliflozin may increase the risk of low blood sugar. Adjustments in the dosage of these medications may be necessary.
• Ketoacidosis: There have been rare reports of ketoacidosis (a serious condition with high levels of acids called ketones in the blood) associated with canagliflozin use. Patients should be monitored for signs and symptoms such as nausea, vomiting, abdominal pain, fatigue, and difficulty breathing.
• Fracture Risk: There is some evidence suggesting an increased risk of bone fractures, particularly in elderly patients, while taking canagliflozin. This risk should be considered in patients with a history of fractures or other risk factors for osteoporosis.
• Surgical Procedures and Contrast Agents: Canagliflozin may need to be temporarily discontinued before scheduled surgeries or procedures involving intravascular administration of iodinated contrast agents, due to the risk of acute kidney injury.
• Pregnancy and Breastfeeding: The safety of canagliflozin during pregnancy and breastfeeding has not been established. It is generally recommended to avoid its use during pregnancy unless clearly necessary and after discussing risks and benefits with a healthcare provider.
• Interactions with Other Medications: Canagliflozin can interact with certain medications, including diuretics, which may increase the risk of dehydration and hypotension. It is important to inform healthcare providers about all medications being taken, including over-the-counter drugs and supplements.

Canagliflozin is primarily indicated for managing type 2 diabetes mellitus, but ongoing research is exploring its potential benefits in other conditions such as heart failure and non-alcoholic fatty liver disease. When using canagliflozin, healthcare providers must carefully assess individual patient factors, including kidney function and potential risks, to ensure safe and effective treatment. Regular monitoring and patient education are essential components of its use.

What special dietary instructions should I follow?

• Fluid Intake: Ensure adequate fluid intake to prevent dehydration, especially if you are elderly or taking diuretics. Drinking water regularly throughout the day is recommended.
• Alcohol Consumption: Limit alcohol intake while taking canagliflozin, as alcohol can increase the risk of hypoglycemia and may exacerbate the risk of ketoacidosis.
• Meal Timing: Canagliflozin does not need to be taken with food, but it can be taken with or without meals. Maintain regular meal schedules to help manage blood sugar levels consistently.

What should I do if I forget a dose?

If you forget to take a dose of canagliflozin, take it as soon as you remember on the same day. If it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take double doses to make up for a missed one.

What side effects can this medication cause?

Canagliflozin, like any medication, can cause side effects. Here are some of the common and less common side effects associated with canagliflozin:

Common Side Effects:

• Genital Yeast Infections: Canagliflozin may increase the risk of genital yeast infections (such as vaginal yeast infections in women and balanitis in men) due to increased glucose in the urine, which can promote fungal growth.
• Urinary Tract Infections (UTIs): There is an increased risk of urinary tract infections with canagliflozin use, possibly due to the presence of glucose in the urine providing a medium for bacterial growth.
• Increased Urination: Canagliflozin works by increasing the excretion of glucose in the urine, which can lead to increased urination (polyuria). This effect typically improves over time as the body adjusts to the medication.
• Thirst: Increased urination may lead to increased thirst (polydipsia) as the body tries to maintain fluid balance.
• Dehydration: In some cases, excessive urination can lead to dehydration, especially in elderly patients or those taking diuretics.
• Low Blood Pressure (Hypotension): Canagliflozin can cause a mild drop in blood pressure, leading to symptoms such as dizziness, lightheadedness, or fainting, especially when standing up from a sitting or lying position.

Less Common or Serious Side Effects:

• Ketoacidosis: Although rare, canagliflozin can increase the risk of ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones. Symptoms include difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue.
• Acute Kidney Injury: There have been reports of acute kidney injury associated with canagliflozin use, particularly when used in conjunction with certain medications or procedures that can stress the kidneys (such as dehydration or contrast agents used in imaging studies).
• Bone Fractures: Some studies have suggested an increased risk of bone fractures, particularly in elderly patients, possibly related to alterations in bone metabolism.
• Hypoglycemia (Low Blood Sugar): When canagliflozin is used in combination with insulin or other diabetes medications that lower blood sugar, there is a potential risk of hypoglycemia. Symptoms may include sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet.
• Hypersensitivity Reactions: Rarely, canagliflozin can cause allergic reactions such as rash, itching, or swelling, especially of the face/tongue/throat, severe dizziness, or trouble breathing.
• Increased LDL Cholesterol Levels: Canagliflozin may cause a slight increase in LDL cholesterol (the “bad” cholesterol) levels.
• Pancreatitis: In rare cases, canagliflozin may be associated with pancreatitis, an inflammation of the pancreas.

It’s important to report any unusual symptoms or side effects to your healthcare provider promptly, especially if they are persistent or severe. Your healthcare provider will monitor your response to canagliflozin and may adjust your treatment regimen if necessary to minimize side effects and optimize diabetes management.

What should I know about storage and disposal of this medication?

Storage and Disposal of Canagliflozin:

• Storage: Canagliflozin tablets should be stored at room temperature between 20°C to 25°C (68°F to 77°F). Keep the medication in its original container or packaging to protect it from moisture and light.
• Disposal: Dispose of unused or expired canagliflozin tablets properly. Follow local regulations or guidelines for medication disposal. Do not flush them down the toilet or pour them into a drain unless instructed to do so.

In case of emergency/overdose

• Symptoms of Overdose: If you suspect an overdose of canagliflozin, symptoms may include severe dehydration, electrolyte imbalance (such as low sodium levels), hypotension (low blood pressure), and possibly ketoacidosis (high blood ketone levels).
• Emergency Actions: If an overdose is suspected, seek immediate medical attention or contact a poison control center right away (in the United States, you can call 1-800-222-1222). Provide as much information as possible about the quantity of medication ingested and any symptoms observed.

What other information should I know?

• Regular Monitoring: Canagliflozin therapy typically requires regular monitoring of kidney function, blood sugar levels, and other relevant parameters as determined by your healthcare provider.
• Lifestyle Considerations: Canagliflozin works best when used in conjunction with a healthy lifestyle, including a balanced diet, regular physical activity, and adherence to other medical recommendations for diabetes management.
• Medical Alerts: Inform all healthcare providers involved in your care, including dentists and specialists, that you are taking canagliflozin. This helps them make informed decisions about your treatment options and medical procedures.
• Follow-up: Attend scheduled follow-up appointments with your healthcare provider to assess your response to canagliflozin and address any concerns or adjustments needed in your treatment plan.
• Medication Interactions: Canagliflozin can interact with other medications, including diuretics, which may require dosage adjustments or careful monitoring. Inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and herbal supplements.
• Pregnancy and Breastfeeding: Canagliflozin is generally not recommended during pregnancy or breastfeeding due to limited safety data. Discuss with your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding.
• Patient Education: Be aware of common side effects and potential signs of complications associated with canagliflozin. Promptly report any new or worsening symptoms to your healthcare provider.

By following these guidelines and staying informed about your medication, you can effectively manage your diabetes while minimizing risks and maximizing the benefits of canagliflozin therapy. Always consult your healthcare provider for personalized advice and guidance related to your specific health needs.