What is the recommended dose of Invokana (canagliflozin) for type 2 diabetes treatment?

Invokana (Canagliflozin) Dosing

Start with 100 mg orally once daily before the first meal for all indications including glycemic control, cardiovascular protection, and renal protection. 1

Standard Dosing Algorithm

Initial Dose

• 100 mg once daily is the recommended starting dose for all patients with type 2 diabetes, regardless of indication (glycemic control, cardiovascular risk reduction, or renal protection). 1
• Take before the first meal of the day. 1

Dose Escalation for Glycemic Control ONLY

• Increase to 300 mg once daily ONLY if additional glycemic control is needed in patients with eGFR ≥60 mL/min/1.73 m². 2, 1
• Do NOT increase the dose for cardiovascular or renal protection—the 100 mg dose provides equivalent benefits, and higher doses offer no additional cardiovascular or renal advantages. 2

Renal Function-Based Dosing

eGFR ≥60 mL/min/1.73 m²

• Start at 100 mg once daily. 1
• May increase to maximum 300 mg once daily if more intensive glycemic control is needed. 2, 1

eGFR 30 to <60 mL/min/1.73 m²

• Maximum dose is 100 mg once daily—do not exceed this dose as efficacy is reduced and safety is not established at higher doses in this population. 2, 1
• For patients already on Invokana with albuminuria >300 mg/day, continue 100 mg once daily for renal and cardiovascular protection. 1

eGFR <30 mL/min/1.73 m²

• Do not initiate Invokana in this population. 1
• Exception: Adult patients already taking Invokana 100 mg with albuminuria >300 mg/day may continue for renal and cardiovascular protection. 1

Special Dosing Situations

Co-administration with UGT Enzyme Inducers (rifampin, phenytoin, phenobarbital, ritonavir)

• If eGFR ≥60 mL/min/1.73 m²: Increase from 100 mg to 200 mg once daily (maximum 300 mg daily). 1
• If eGFR <60 mL/min/1.73 m²: Increase to maximum 200 mg once daily. 1

Concomitant Glucose-Lowering Medications

• Reduce or stop sulfonylureas/glinides if HbA1c is well-controlled at baseline or if patient has frequent hypoglycemia. 2
• Reduce total daily insulin dose by approximately 20% when initiating Invokana to prevent hypoglycemia. 2

Volume Depletion Risk

• Consider stopping or reducing diuretic dose before initiating Invokana, as it may contribute to intravascular volume contraction. 2

Pre-Surgical Management

• Discontinue Invokana at least 3 days before planned surgery or procedures with prolonged fasting to prevent postoperative ketoacidosis. 2, 1
• Resume when patient is clinically stable and has resumed oral intake. 1

Common Pitfalls to Avoid

• Do not escalate to 300 mg for cardiovascular or renal protection—this is a glycemic control dose only and provides no additional organ protection benefits. 2
• Do not exceed 100 mg daily in patients with eGFR 30-59 mL/min/1.73 m²—higher doses are ineffective and potentially unsafe in this population. 2, 1
• Do not forget to assess renal function before initiating and monitor as clinically indicated. 1
• Do not initiate in volume-depleted patients without correcting volume status first. 1