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.
Drug Guide, © 2015 Farlex and Partners
References in periodicals archive ?
- The licence extension submission for Invokana (canagliflozin) and Vokanamet (canagliflozin and metformin) to treat type 2 diabetes mellitus patients with chronic kidney disease will now be reviewed by the Committee for Medicinal Products for Human Use, Invokana and Vokanamet European distributor Mundipharma said.
Release date- 23082019 - CAMBRIDGE - As the European distributor of Invokana (canagliflozin) and Vokanamet (canagliflozin and metformin), Mundipharma welcomes the news that the European Medicines Agency (EMA) has accepted the licence extension submission for these two medicines to treat stage 2 or stage 3 chronic kidney disease (CKD) and albuminuria as an adjunct to standard of care in adults with type 2 diabetes mellitus (T2DM).
The European Medicines Agency (EMA) has granted a licence extension submission to United Kingdom-based Mundipharma's Invokana (canagliflozin) and Vokanamet (canagliflozin and metformin) to treat stage two or stage three chronic kidney disease and albuminuria as an adjunct to standard of care in adults with type two diabetes mellitus (T2DM), it was reported yesterday.
Patients received either the SGLT2 inhibitor canagliflozin (Invokana) or placebo.
The new study tested Invokana, a daily pill sold now to help control blood sugar, to see if it also could help prevent kidney disease when added to standard treatments.
Additionally, Johnson & Johnson will continue to serve those impacted by diabetes through innovative products, services and solutions from its Medical Device, Pharmaceuticals and Consumer businesses in bariatric surgery as well as through INVOKANA (canagliflozin) and INVOKAMET (canagliflozin/metformin HCl) medicines.
The medications in question are sodium-glucose contransporter-2 (SGLT2) inhibitors made by Invokana, Farxiga, and Jardiance.
FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR).
These include areas such as bariatric surgery and medicines such as INVOKANA (canagliflozin) and INVOKAMET (canagliflozin/metformin HCl).
Similar benefits were subsequently documented with another SGLT-2 inhibitor, canagliflozin (Invokana), in the CANVAS study program (N EnglJ Med.