Brand Name of Canagliflozin
The brand name for canagliflozin is Invokana. 1
Overview of Canagliflozin
Canagliflozin (Invokana) is an SGLT2 inhibitor approved for the treatment of type 2 diabetes mellitus. It works by inhibiting sodium-glucose cotransporter 2 (SGLT2) proteins in the kidneys, which reduces glucose reabsorption and increases urinary glucose excretion, thereby lowering blood sugar levels 2, 1.
Indications for Canagliflozin (Invokana)
Canagliflozin is FDA-approved for:
- Improving glycemic control in adults with type 2 diabetes as an adjunct to diet and exercise 3
- Reducing the risk of myocardial infarction, stroke, or cardiovascular death in adults with type 2 diabetes and cardiovascular disease 3
- Reducing the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in patients with type 2 diabetes and diabetic nephropathy with albuminuria 3, 1
Dosage and Administration
- Recommended dose: 100 mg orally once daily 3
- Maximum dose: 300 mg orally once daily 3
- Dose modifications for renal impairment:
- eGFR 30-59 ml/min/1.73 m²: maximum dose 100 mg daily
- eGFR <30 ml/min/1.73 m²: use is not recommended 3
Cardiovascular and Renal Benefits
Canagliflozin has demonstrated significant cardiovascular and renal benefits in clinical trials:
- In the CANVAS Program, canagliflozin significantly reduced the composite outcome of cardiovascular death, MI, or stroke versus placebo (HR 0.86 [95% CI 0.75-0.97]) 3
- In patients with diabetic nephropathy, canagliflozin reduced the risk of the primary composite outcome (end-stage kidney disease, doubling of serum creatinine, or death from renal or cardiovascular causes) by 30% compared to placebo 3
Safety Considerations
- Common adverse effects include genital mycotic infections and urinary tract infections 2, 4
- Risk of volume depletion/hypotension, particularly in elderly patients and those on diuretics 3, 1
- Increased risk of lower-limb amputation (6.3 vs. 3.4 participants per 1,000 patient-years; HR 1.97 [95% CI 1.41-2.75]) 3
- Risk of euglycemic diabetic ketoacidosis, particularly in patients with type 1 diabetes (not FDA approved for type 1 diabetes) 5
- Should be discontinued at least 3 days before scheduled surgery to prevent postoperative ketoacidosis 3
Practical Considerations
- When initiating canagliflozin in patients already on insulin or sulfonylureas, consider reducing sulfonylurea dose by 50% or total daily insulin dose by approximately 20% to prevent hypoglycemia 2
- Monitor renal function regularly, especially in elderly patients or those at risk for volume depletion 1
- Use with caution in patients with prior amputation or severe peripheral neuropathy 3
Canagliflozin (Invokana) represents an important therapeutic option for patients with type 2 diabetes, offering benefits beyond glycemic control including cardiovascular and renal protection.