canagliflozin

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Related to Invokana: canagliflozin, metformin, Victoza

canagliflozin

(kan-a-gli-floe-zin ) ,

Invokana

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: sodium glucose co transporter 2 sglt2 inhibitors
Pregnancy Category: C

Indications

Adjunct to diet and exercise in the management of type 2 diabetes mellitusMay be used with other antidiabetic agents.

Action

Inhibits proximal renal tubular sodium-glucose co-transporter 2 (SGLT2), which determines reabsorption of glucose from the tubular lumen. Inhibits reabsorption of glucose, lowers renal threshold for glucose, and increases excretion of glucose in urine.

Therapeutic effects

Improved glycemic control

Pharmacokinetics

Absorption: Well absorbed (65%) following oral administration
Distribution: Extensive tissue distribution
Protein Binding: 99%
Metabolism and Excretion: Mostly metabolized by UDP-glucuronyl transferases (UGT) to inactive metabolites, minimal metabolism by CYP3A4 (7%). 50% excreted in feces as parent drug and metabolites, 33% as metabolites in urine, <1% excreted in urine as unchanged drug.
Half-life: 10.6 hr

Time/action profile (effects on HbA1C)

ROUTEONSETPEAKDURATION
POunknownunknown24 hr

Contraindications/Precautions

Contraindicated in: HypersensitivitySevere renal impairment (eGFR <45 mL/min/1.73 m2), end-stage renal disease or on dialysis;Severe hepatic impairment; Lactation: Avoid use, discontinue breast feeding or discontinue canagliflozin.
Use Cautiously in: eGFR <60 mL/min/1.73 m2 (monitor frequently), ↑ risk of adverse reactions related to ↓ intravascular volume; Geriatric: ↑ risk of adverse reactions related to ↓ intravascular volume;Hypotension (correct prior to treatment, especially if eGFR 30–60 mL/min, age >75 yr, or concurrent use of loop diuretics, ACE inhibitors, or ARBs; Obstetric: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; Pediatric: Safe and effective use in children <18 yr has not been established.

Adverse Reactions/Side Effects

Cardiovascular

  • hypotension

Gastrointestinal

  • abdominal pain
  • constipation
  • nausea

Genitourinary

  • female mycotic infections (most frequent)
  • glucosuria
  • male mycotic infections
  • ↓ renal function
  • urinary tract infection
  • ↑ urination
  • vulvovaginal pruritus

Endocrinologic

  • hypoglycemia (with other medications) (life-threatening)

Fluid and Electrolyte

  • hyperkalemia (most frequent)
  • hypermagnesemia
  • hyperphosphatemia
  • thirst

Metabolic

  • hyperlipidemia

Miscellaneous

  • hypersensitivity reactions, including generalized urticaria

Interactions

Drug-Drug interaction

Blood levels are ↓ by UGT inducers including phenobarbital, phenytoin, rifampin, and ritonavir ; ↑dose may be required.↑ risk of hypoglycemia with insulin or insulin secretagogues, dose adjustments may be required.May↑ blood levels and effects of digoxin ; levels should be monitored.↑ risk of hyperkalemia with potassium-sparing diuretics or medications that interfere with the renin-angiotnesin-aldosterone system.

Route/Dosage

Oral (Adults) eGFR ≥ 60 mL/min/1.73 m2—100 mg once daily initially, may be increased to 300 mg once daily; Concurrent use of UGT inducers (phenobarbital, phenytoin, rifampin, ritonavir)—if maintenance dose is 100 mg daily, may require increase to 300 mg daily.

Renal Impairment

Oral (Adults) eGFR 45–60 mL/min/1.73 m2100 mg once daily

Availability

Tablets: 100 mg, 300 mg

Nursing implications

Nursing assessment

  • Observe patient for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety)
  • Monitor for signs and symptoms of volume depletion (dizziness, feeling faint, weakness, orthostatic hypotension) after initiating therapy.
  • Lab Test Considerations: Monitor hemoglobin A1C prior to and periodically during therapy
    • May cause ↑ uric acid levels
    • May ↑serum creatinine and ↓eGFR. Monitor renal function, especially in patients with eGFR <60 mL/min/1.73 m2
    • May cause ↑ serum potassium, magnesium, and phosphate levels. Monitor electrolytes periodically during therapy.
    • May cause ↑ LDL-C. Monitor serum lipid levels periodically during therapy.

Potential Nursing Diagnoses

Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin
  • Correct volume depletion prior to beginning therapy with canagliflozin.
  • Oral: Administer before the first meal of the day.

Patient/Family Teaching

  • Instruct patient to take canagliflozin as directed. Take missed doses as soon as remembered, unless it is almost time for next dose; do not double doses. Advise patient to read the Medication Guide before starting and with each Rx refill; new information may be available
  • Explain to patient that canagliflozin helps control hyperglycemia but does not cure diabetes. Therapy is usually long term
  • Instruct patient not to share this medication with others, even if they have the same symptoms; it may harm them
  • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes
  • Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional
  • Instruct patient in proper testing of blood glucose and urine ketones. Inform patient that canagliflozin will cause a positive test result when testing for urine glucose. These tests should be monitored closely during periods of stress or illness and health care professional notified if significant changes occur
  • Inform patient that canagliflozin may cause yeast infections. Women may have signs and symptoms of a vaginal yeast infection (vaginal odor, white or yellow vaginal discharge [may be lumpy or look like cottage cheese], vaginal itching). Men may have signs and symptoms of a yeast infection of the penis (redness, itching, or swelling of penis; rash on penis; foul smelling discharge from penis; pain in skin around penis). Advise patient to notify health care professional if yeast infection occurs.
  • Advise patient to notify health care professional promptly if rash; hives; or swelling of face, lips, or throat occur
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially other oral hypoglycemic medications
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding

Evaluation/Desired Outcomes

  • Improved hemoglobin A1C and glycemic control in adults with Type II diabetes.
References in periodicals archive ?
Following the run-in period, patients were randomized to INVOKANA 100 mg, INVOKANA 300 mg, or placebo, administered once daily as add-on to metformin and sulfonylurea.
These findings show the use of INVOKANA in people with type 2 diabetes leads to reduced A1C levels and, for many, achievement of treatment goals.
The drug managed to control glucose and sustain weight loss, but will be playing catch-up with J&J's Invokana if it gets approved in early 2014.
Clinical trial and real-world findings on efficacy and persistence with INVOKANA 100 mg and 300 mg compared to DPP-4 inhibitors
The studies showed that the combination of INVOKANA and metformin lowered blood sugar and, in pre-specified secondary endpoints, was associated with significant reductions in body weight and systolic blood pressure.
The Janssen Pharmaceutical Companies of Johnson & Johnson has revealed results of a new analysis indicating that Invokana (canagliflozin) significantly decreased the risk of cardiovascular death or hospitalisation for heart failure in patients with type two diabetes at high cardiovascular risk, it was reported on Tuesday.
M2 PHARMA-March 14, 2018-Janssen Pharmaceutical reveals results of new analysis of Invokana
Late-breaking data include results from the CANVAS program for INVOKANA (canagliflozin) in type 2 diabetes (T2D), an analysis from COMPASS for XARELTO (rivaroxaban) in peripheral artery disease (PAD), and one-year results from the mHealth Screening To Prevent Strokes (mSToPS) study, examining the use of wearable electrocardiogram (ECG) sensor technology in detecting atrial fibrillation (AFib).
For instance, in 2015, Janssen India launched INVOKANA for diabetic patients.
These include important leadership and innovation in areas such as bariatric surgery and through medicines such as INVOKANA (canagliflozin) and INVOKAMET (canagliflozin/metformin HCl).
Express Scripts identified the top five most costly medications as Lantus, Humalog KwikPen, metformin, Januvia, and Invokana.
It noted results of one test showed that in one year, the risk of amputation in patients treated with Invokana was equivalent to 5.