Nurses Compass
Drug Guide
Canagliflozin
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/ADrug-Herb Interactions
N/ANursing 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.