Home Drug Guide Canagliflozin

Drug Guide

Generic Name

Canagliflozin

Brand Names Invokana

Classification

Therapeutic: Antidiabetic agent

Pharmacological: SGLT2 inhibitor

FDA Approved Indications

  • Type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Inhibits sodium-glucose co-transporter 2 (SGLT2) in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion.

Dosage and Administration

Adult: Start at 100 mg once daily before the first meal; can be increased to 300 mg based on efficacy and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider renal function.

Renal Impairment: Use is not recommended if eGFR is below 30 mL/min/1.73 m²; adjust dose accordingly.

Hepatic Impairment: No specific adjustments necessary.

Pharmacokinetics

Absorption: Rapidly absorbed with peak plasma concentrations in 1-2 hours.

Distribution: Approximately 55% bound to plasma proteins.

Metabolism: Primarily excreted unchanged; minimal hepatic metabolism.

Excretion: Primarily via urine (about 55%) and feces.

Half Life: Approximately 10.6 hours.

Contraindications

  • Severe renal impairment (eGFR <30 mL/min/1.73 m²)

Precautions

  • Risk of genital mycotic infections, urinary tract infections, hypotension, ketoacidosis, and volume depletion. Use with caution in patients with hypotension or on diuretics.

Adverse Reactions - Common

  • Genital mycotic infections (Common)
  • Urinary tract infections (Common)
  • Increased urination (Common)

Adverse Reactions - Serious

  • Ketoacidosis (Rare)
  • Acute kidney injury (Rare)
  • Hypotension (Uncommon)

Drug-Drug Interactions

  • Diuretics, insulin, insulin secretagogues, RAAS inhibitors

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose, renal function, blood pressure, signs of infection.

Diagnoses:

  • Risk for hypoglycemia when used with insulin or secretagogues.
  • Risk for urinary and genital infections.

Implementation: Administer before the first meal, monitor renal function and blood glucose regularly, counsel patient on signs of infections.

Evaluation: Assess blood glucose response, renal function, and side effects.

Patient/Family Teaching

  • Take with first meal of the day.
  • Maintain good genital hygiene.
  • Report signs of infection, dehydration, or ketoacidosis immediately.
  • Stay hydrated.

Special Considerations

Black Box Warnings:

  • Risk of diabetic ketoacidosis (serious and potentially fatal), which may occur with or without precipitating factors.

Genetic Factors: None specific.

Lab Test Interference: May cause false-positive ketone tests.

Overdose Management

Signs/Symptoms: Hypotension, dehydration, nausea, vomiting, dizziness.

Treatment: Discontinue medication, provide hydration, monitor vital signs, and supportive care as needed.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable until the expiration date on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.