canagliflozin (Rx)

Brand and Other Names:Invokana
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 100mg
  • 300mg

Type 2 Diabetes Mellitus

Initial: 100 mg PO qDay taken before the first meal of the day

May increase dose to 300 mg qDay if 100 mg/day tolerated in patients who have eGFR ≥60 mL/min/1.73 m² and require additional glycemic control

Indications

  • Indicated as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus (T2DM)
  • Also indicated to reduce risk of major adverse cardiovascular events (cardiovascular death, nonfatal MI and stroke) in adults with T2DM and established cardiovascular disease
  • Indicated to reduce the risk of end-stage kidney disease (ESKD), doubling of serum creatinine, cardiovascular (CV) death, and hospitalization for heart failure in adults with T2DM and diabetic nephropathy with albuminuria ˃300 mg/day

Dosage Modifications

Renal impairment

  • eGFR ≥60 mL/min/1.73 m2: No dosage adjustment necessary
  • eGFR 30 to <60 mL/min/1.73 m2: 100 mg qDay
  • eGFR <30 mL/min/1.73 m2 with albuminuria >300 mg/day: 100 mg qDay to reduce risk of end-stage kidney disease, doubling of serum creatinine, CV death, and hospitalization for heart failure
  • eGFR <30 mL/min/1.73 m2: Initiation not recommended
  • On dialysis: Contraindicated

UGT enzyme inducers

  • eGFR ≥60 mL/min/1.73 m2
    • May increase canagliflozin dose to 200 mg qDay if currently tolerating 100 mg/day
    • May increase canagliflozin dose to 300 mg qDay if currently tolerating 200 mg/day
  • eGFR <60 mL/min/1.73 m2
    • May increase canagliflozin dose to 200 mg qDay if currently tolerating 100 mg/day
    • Consider adding another antihyperglycemic agent in patients who require additional glycemic control

Hepatic impairment

  • Mild-to-moderate: No dosage adjustment is necessary
  • Severe: Not studied and is therefore not recommended

Dosing Considerations

Not recommended for treating type 1 diabetes mellitus or diabetic ketoacidosis

Before initiating treatment

  • Correct volume depletion
  • Assess renal function and periodically thereafter

Safety and efficacy not established

Patients aged ≥65 years had a higher incidence of adverse reactions related to reduced intravascular volume (eg, hypotension, postural dizziness, orthostatic hypotension, syncope, dehydration), particularly with the 300 mg daily dose, compared with younger patients; a more prominent increase in the incidence was seen in patients who were ≥75 years

Smaller reductions in HbA1C compare to placebo were seen in older (≥65 years; -0.61% with 100-mg dose and -0.74% with 300-mg dose relative to placebo) compared with younger patients

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Interactions

Interaction Checker

and canagliflozin

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              Serious - Use Alternative (0)

                Monitor Closely (69)

                • aliskiren

                  aliskiren and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • amiloride

                  amiloride and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • azilsartan

                  azilsartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • benazepril

                  benazepril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • betrixaban

                  canagliflozin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

                • candesartan

                  candesartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • captopril

                  captopril and canagliflozin both increase serum potassium. Use Caution/Monitor. Monitor potassium

                • carbamazepine

                  carbamazepine decreases levels of canagliflozin by increasing metabolism. Use Caution/Monitor. Coadministration with potent UGT enzyme inducers: Consider increasing dose to 300 mg qDay if 100 mg/day tolerate and additional glycemic control required (eGFR must be >60 mL/min/1.73 m2 to increase dose); if eGFR <60 mL/min/1.73 m2, consider using a different antihyperglycemic agent.

                • chlorpropamide

                  chlorpropamide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • cyclosporine

                  cyclosporine and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • digoxin

                  canagliflozin increases levels of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Digoxin AUC and peak serum concentration increased when coadministered with canagliflozin.

                • drospirenone

                  drospirenone and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • dulaglutide

                  dulaglutide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • enalapril

                  enalapril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • eplerenone

                  eplerenone and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • eprosartan

                  eprosartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • finerenone

                  canagliflozin and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

                • fosinopril

                  fosinopril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • glimepiride

                  glimepiride, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • glipizide

                  glipizide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • glyburide

                  glyburide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • heparin

                  heparin and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • insulin aspart

                  insulin aspart, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin aspart protamine/insulin aspart

                  canagliflozin, insulin aspart protamine/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin degludec

                  canagliflozin, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin degludec/insulin aspart

                  canagliflozin, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin detemir

                  insulin detemir, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin detemir. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin glargine

                  insulin glargine, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin glargine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin glulisine

                  insulin glulisine, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin glulisine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin inhaled

                  canagliflozin, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin isophane human/insulin regular human

                  canagliflozin, insulin isophane human/insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin lispro

                  insulin lispro, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin lispro protamine/insulin lispro

                  canagliflozin, insulin lispro protamine/insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin NPH

                  insulin NPH, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin NPH. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • insulin regular human

                  insulin regular human, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                  canagliflozin, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

                • irbesartan

                  irbesartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • letermovir

                  letermovir will increase the level or effect of canagliflozin by unspecified interaction mechanism. Use Caution/Monitor. Monitor glucose concentrations.

                • lisinopril

                  lisinopril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • losartan

                  losartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • moexipril

                  moexipril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • nateglinide

                  nateglinide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • olmesartan

                  olmesartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • pentamidine

                  pentamidine and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • perindopril

                  perindopril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • phenobarbital

                  phenobarbital decreases levels of canagliflozin by increasing metabolism. Use Caution/Monitor. Coadministration with potent UGT enzyme inducers: Consider increasing dose to 300 mg qDay if 100 mg/day tolerate and additional glycemic control required (eGFR must be >60 mL/min/1.73 m2 to increase dose); if eGFR <60 mL/min/1.73 m2, consider using a different antihyperglycemic agent.

                • phenytoin

                  phenytoin decreases levels of canagliflozin by increasing metabolism. Use Caution/Monitor. Coadministration with potent UGT enzyme inducers: Consider increasing dose to 300 mg qDay if 100 mg/day tolerate and additional glycemic control required (eGFR must be >60 mL/min/1.73 m2 to increase dose); if eGFR <60 mL/min/1.73 m2, consider using a different antihyperglycemic agent.

                • potassium acid phosphate

                  potassium acid phosphate and canagliflozin both increase serum potassium. Modify Therapy/Monitor Closely.

                • potassium chloride

                  potassium chloride and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • potassium citrate

                  potassium citrate and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • potassium citrate/citric acid

                  canagliflozin and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

                • potassium phosphates, IV

                  potassium phosphates, IV and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • quinapril

                  quinapril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • ramipril

                  ramipril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • repaglinide

                  repaglinide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • rifampin

                  rifampin decreases levels of canagliflozin by increasing metabolism. Use Caution/Monitor. Coadministration with potent UGT enzyme inducers: Consider increasing dose to 300 mg qDay if 100 mg/day tolerate and additional glycemic control required (eGFR must be >60 mL/min/1.73 m2 to increase dose); if eGFR <60 mL/min/1.73 m2, consider using a different antihyperglycemic agent.

                • ritonavir

                  ritonavir decreases levels of canagliflozin by increasing metabolism. Use Caution/Monitor. Coadministration with potent UGT enzyme inducers: Consider increasing dose to 300 mg qDay if 100 mg/day tolerate and additional glycemic control required (eGFR must be >60 mL/min/1.73 m2 to increase dose); if eGFR <60 mL/min/1.73 m2, consider using a different antihyperglycemic agent.

                • sacubitril/valsartan

                  sacubitril/valsartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • somapacitan

                  somapacitan decreases effects of canagliflozin by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone products may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating somapacitan. .

                • spironolactone

                  spironolactone and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • succinylcholine

                  succinylcholine and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • tacrolimus

                  tacrolimus and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • telmisartan

                  telmisartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • tolazamide

                  tolazamide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • tolbutamide

                  tolbutamide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

                • trandolapril

                  trandolapril and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • triamterene

                  triamterene and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • trimethoprim

                  trimethoprim and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • valsartan

                  valsartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

                • voclosporin

                  voclosporin and canagliflozin both increase serum potassium. Use Caution/Monitor.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Female genital mycotic infections (10.4-11.4%)

                  1-10%

                  Urinary tract infections (4.4-5.9%)

                  Increased urination (4.6-5.1%)

                  Male genital mycotic infections (3.8-4.2%)

                  Thirst (2.4-2.8%)

                  Constipation (1.8-2.4%)

                  Nausea (2.1-2.3%)

                  Volume depletion

                  • Overall population (2.3-3.4%)
                  • Age >75 yr (4.9-8.7%)
                  • eGFR <60/mL/min/1.73 m³ (4.7-8.1%)
                  • Use of loop diuretic (3.2-8.8%)

                  Postmarketing reports

                  Ketoacidosis

                  Acute kidney injury

                  Anaphylaxis

                  Angioedema

                  Urosepsis

                  Pyelonephritis

                  Necrotizing fasciitis of the perineum (Fournier’s gangrene)

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                  Warnings

                  Contraindications

                  Serious hypersensitivity reaction (eg, anaphylaxis, angioedema)

                  Patients on dialysis

                  Cautions

                  Causes intravascular volume contraction and symptomatic hypotension and/or acute kidney injury can occur, particularly if eGFR <60 mL/min/1.73 m2, advance age, existing low systolic BP, or taking either diuretics or drugs that interfere with renin-angiotensin-aldosterone system (RAS) (eg, ACE inhibitors, ARBs); monitor for signs and symptoms during therapy

                  Increases in serum creatinine and decreases in estimated GFR also observed with initiation

                  Increases risk of urinary tract infections (UTIs), including life-threatening urosepsis and pyelonephritis that started as UTIs; evaluate patients for signs and symptoms of urinary tract infections and treat promptly, if indicated

                  Necrotizing fasciitis of the perineum (Fournier gangrene) reported with SGLT2 inhibitors; signs and symptoms include tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, and have a fever >100.4ºF or a general feeling of being unwell; if suspected, discontinue SGLT2 inhibitor and start treatment immediately with broad-spectrum antibiotics and surgical debridement if necessary

                  Genital mycotic infections may occur, patients with history of genital mycotic infections and uncircumcised males are more susceptible

                  Increased risk of bone fracture, occurring as early as 12 weeks after treatment initiation, reported; consider factors that contribute to fracture risk before initiating therapy

                  Hypersensitivity reactions, including angioedema and anaphylaxis reported; reactions generally occurred within hours to days after initiation; if hypersensitivity reactions occur, discontinue therapy; treat and monitor until signs and symptoms resolve

                  Lower limb amputation

                  • Increased risk of lower limb amputations associated with canagliflozin use was observed in 2 large, randomized, placebo-controlled trials (CANVAS AND CANVAS-R) in patients with type 2 diabetes who had established cardiovascular disease (CVD) or were at risk for CVD
                  • 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 (eg, history of prior amputation, peripheral vascular disease, neuropathy, diabetic foot ulcers)
                  • Monitor for infection, new pain or tenderness, and sores or ulcers involving the lower limbs; discontinue if these complications occur

                  Ketoacidosis

                  • Ketoacidosis associated with SGLT2 inhibitors reported; monitor for signs and symptoms of ketoacidosis (eg, difficulty breathing, nausea, vomiting, abdominal pain, confusion, unusual fatigue or sleepiness)
                  • Before initiating therapy, consider factors in patient history that may predispose to ketoacidosis, including pancreatic insulin deficiency from any cause, caloric restriction, and alcohol abuse
                  • Consider temporarily discontinuing canagliflozin for at least 3 days before undergoing scheduled surgery to avoid euglycemic ketoacidosis
                  • Consider monitoring for ketoacidosis and temporarily discontinuing therapy in other clinical situations known to predispose to ketoacidosis (eg, prolonged fasting due to acute illness or post-surgery)
                  • Restart once the patient’s oral intake is back to baseline and any other risk factors for ketoacidosis (blood acid buildup) are resolved

                  Drug interaction overview

                  • Major substrate of UGT1A9 and UGT2B4; weak inhibitor of P-gp
                  • Coadministration of canagliflozin with rifampin, a nonselective inducer of several UGT enzymes, including UGT1A9, UGT2B4, decreased canagliflozin AUC by 51%
                  • Hypoglycemia risk increased with insulin and insulin secretagogues, consider a lower dose of insulin or the insulin secretagogue
                  • An increase in AUC and mean peak drug concentration of digoxin (a P-gp substrate) was observed when coadministered with canagliflozin 300 mg; monitor

                  Laboratory testing

                  • 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
                  • 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
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                  Pregnancy & Lactation

                  Pregnancy

                  Based on animal data showing adverse renal effects, not recommended during the second and third trimesters of pregnancy

                  Data are limited in pregnant women and are not sufficient to determine a drug associated risk for major birth defects or miscarriage

                  Clinical considerations

                  • Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, stillbirth, and delivery complications
                  • Poorly controlled diabetes increases fetal risk for major birth defects, stillbirth, and macrosomia related morbidity

                  Lactation

                  No information regarding distribution in human milk or effects on the breastfed infant or milk production

                  Present in milk of lactating rats

                  Since human kidney maturation occurs in utero and during the first 2 yr of life when lactational exposure may occur, there may be risk to the developing human kidney

                  Inform women not to breastfeed while taking canagliflozin

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Selective sodium-glucose transporter-2 (SGLT2) inhibitor

                  SGLT-2 inhibition lowers the renal glucose threshold (ie, the plasma glucose concentration which exceed the maximum glucose reabsorption capacity of the kidney); lowering the renal glucose threshold results in increased urinary glucose excretion

                  Absorption

                  Bioavailability: 65%

                  Peak plasma time: 1-2 hr

                  Distribution

                  Protein bound: 99% (predominantly to albumin)

                  Vd: 119 L

                  Metabolism

                  O-glucuronidation is the major metabolic elimination pathway, mainly by UGT1A9 and UGT2B4 to 2 inactive O-glucuronide metabolites

                  CYP3A4-mediated (oxidative) metabolism is minimal (~7%)

                  Elimination

                  Half-life: 10.6 hr (100 mg dose); 13.1 hr (300 mg dose)

                  Total body clearance: 192 mL/min

                  Excretion

                  • Feces: 41.5% (canagliflozin), 7% (hydroxylated metabolite), 3.2% (O-glucuronide metabolite)
                  • Urine: 33% excreted in urine, mainly as O-glucuronide metabolites (30.5%); <1% excreted unchanged
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                  Administration

                  Oral Administration

                  Take orally with or without food

                  Missed dose

                  • If dose missed, take as soon as possible
                  • If it is almost time for next dose, skip missed dose and administer next scheduled dose
                  • Do not to take 2 doses at the same time

                  Storage

                  Capsules: Store at 20-25ºC (68-77ºF); excursions permitted between 15-30ºC (59-86ºF)

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                  Images

                  BRAND FORM. UNIT PRICE PILL IMAGE
                  Invokana oral
                  -
                  300 mg tablet
                  Invokana oral
                  -
                  100 mg tablet

                  Copyright © 2010 First DataBank, Inc.

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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                  NC NOT COVERED – Drugs that are not covered by the plan.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.