From the Guidelines
Invokana (canagliflozin) is recommended at an initial dose of 100 mg once daily for patients with type 2 diabetes, with the option to increase to 300 mg once daily if needed for better glycemic control and if the patient tolerates the medication well. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
Key Considerations
- Invokana works by inhibiting sodium-glucose cotransporter 2 (SGLT2) in the kidneys, reducing glucose reabsorption and increasing urinary glucose excretion, thereby lowering blood glucose levels.
- Patients should maintain adequate hydration while taking this medication and be aware of potential side effects including genital mycotic infections, urinary tract infections, and increased urination.
- Invokana should be used cautiously in patients with renal impairment and is not recommended for those with severe kidney disease (eGFR less than 30 mL/min/1.73 m²) 1.
- The medication should be taken as part of a comprehensive diabetes management plan that includes diet, exercise, and possibly other antidiabetic medications.
- Regular monitoring of kidney function, blood pressure, and cholesterol levels is important during treatment, as Invokana has shown cardiovascular and renal protective benefits beyond glucose control in certain patient populations 1.
Important Safety Information
- Canagliflozin has been associated with an increased risk of lower-limb amputation and fracture, and should be used with caution in patients with prior amputation, severe peripheral neuropathy, severe peripheral vascular disease, or active diabetic foot ulcers or soft tissue infections 1.
- The medication should be discontinued at least 3 days before a planned surgery to prevent postoperative ketoacidosis.
- Patients should be aware of the potential for diabetic ketoacidosis and seek medical attention immediately if symptoms occur.
Dose Adjustments
- For patients with eGFR 30 to 59 mL/min/1.73 m², the maximum dose of canagliflozin is 100 mg daily 1.
- For patients with eGFR less than 30 mL/min/1.73 m², canagliflozin is not recommended for glycemic control.
From the FDA Drug Label
INVOKANA (canagliflozin) is indicated: as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus The recommended starting dosage of INVOKANA is 100 mg orally once daily to improve glycemic control, taken before the first meal of the day For additional glycemic control, the dosage of INVOKANA may be increased to the maximum recommended dosage of 300 mg once daily
The recommended usage of Invokana (canagliflozin) for patients with type 2 diabetes is:
- As an adjunct to diet and exercise to improve glycemic control
- Starting dosage: 100 mg orally once daily
- Maximum recommended dosage: 300 mg once daily
- To be taken before the first meal of the day 2
From the Research
Recommended Usage of Invokana (Canagliflozin) for Patients with Type 2 Diabetes
The recommended usage of Invokana (canagliflozin) for patients with type 2 diabetes is as follows:
- Canagliflozin is an inhibitor of sodium-glucose cotransporters type 2 (SGLT2) that are present in renal tubules, promoting glucosuria and reducing fasting and postprandial glycaemia and glycated haemoglobin (HbA(1c)) 3.
- The treatment should be stopped if estimated glomerular filtration rate is below 45 ml/min/1.73 m2, as its efficacy is decreased in patients with renal insufficiency 3.
- Canagliflozin is commercialized under the trade name Invokana, at the doses of 100 mg and 300 mg once daily, for the treatment of type 2 diabetes 3.
- The mean reduction in HbA(1c) averages 0.75% when added to other treatments, as compared to placebo 3.
Dosage and Administration
- Canagliflozin can be used as monotherapy or as add-on therapy to other antihyperglycaemic agents, including metformin, sulfonylurea, and insulin 4, 5, 6.
- The 100 mg dose is as active as sitagliptin 100 mg, while the 300 mg canagliflozin dose is even more efficacious 3.
- Canagliflozin has a low risk of hypoglycaemia and was generally well tolerated in clinical trials, with the most frequently reported adverse events being female genital mycotic infections, urinary tract infections, and increased urination 3, 4, 5.
Special Considerations
- Caution is required in elderly patients, and the risk of volume depletion should be checked (hypotension) 3.
- Canagliflozin promotes weight loss and lowers arterial (mainly systolic) blood pressure, which contribute to the overall benefit 3, 4, 7.
- The combination of canagliflozin with metformin extended release in a single tablet given once daily can help simplify therapy and improve medication adherence in type 2 diabetes patients 7, 6.