Canagliflozin and Metformin (Oral Route)

Used alongside diet and exercise, the combination Canagliflozin and Metformin is used to control blood sugar levels in patients with type II diabetes.

Overview:

The combination of Canagliflozin and Metformin is used in the treatment of type II diabetes.

Type II diabetes is a condition where the pancreas fails to produce enough insulin or the body’s cells have ceased to react to insulin. This condition can cause serious long-term health problems including blindness and kidney failure. People with diabetes are also five times more likely to have a stroke or to develop cardiovascular disease.

Canagliflozin works to prevent the absorption of glucose into the kidney, which prevents it from making it back into the blood. Instead this glucose is excreted and this helps to lower the blood sugar level in the patient.

Metformin reduces the rate of absorption of sugar from the stomach, reduces the liver’s ability to release sugar into the blood and helps your body to use sugar more effectively. This medication also increases the body’s response to insulin.

These treatments will not help patients who have type I diabetes. These patients need to use insulin injections to control their condition.

This treatment should always be prescribed alongside advice on how to maintain a healthy diet and get the right level of exercise. Patients with type II diabetes are at increased risk of serious medical conditions and should take steps to reduce these risks through exercise and healthy living. Type II diabetes will not be cured by this medication. Instead, this medication is used to combat the symptoms of diabetes and prevent a worsening of the condition.

This treatment is available only with a doctor’s prescription and is available as either a tablet or extended-release tablet to be taken orally. Patients should not consume large quantities of alcohol with this medication. This will put them at serious risk of suffering hypoglycemia.

Condition treated:

  • Type II diabetes
  • High blood sugar level

Type of medicine

  • Canagliflozin – Sodium-glucose cotransporter 2 inhibitor
  • Metformin - Biguanides

Side Effects:

Along with the necessary side effects of this treatment, the combined medications Canagliflozin and Metformin can cause unwanted side effects in the body. Some of these side effects may require medical attention if they do occur.

If any of the following side effects occur then you should immediately contact your doctor. The following are potential signs of serious medical complications:

Occurring commonly:

• Abdominal discomfort or stomach pain
• Bladder pains
• Bloody or cloudy urine
• Decreased hunger
• Diarrhea
• Difficult or painful urination
• Fast or shallow breathing
• Frequent or increased urge to urinate
• Frequent urination
• General feeling of discomfort
• Increased urge to urinate when sleeping
• Increased volume of urine
• Itching of or around the vagina or genitals
• Itching or redness of the vaginal area
• Lower back or side pain
• Muscle pains or cramping
• Nausea
• Shortness of breath
• Sleepiness
• Thick white discharge from the vaginal area. This may be mild with no odor
• Unusual tiredness
• Unusual weakness
• Waking to urinate in the night

Occurring less commonly:

• Dry mouth
• Increased thirst

Frequency of incidence not known:

• Anxiousness
• Blurry vision
• Chills
• Cold sweats
• Coma or unconsciousness
• Confusion or disorientation
• Cool skin or pale skin
• Depression or unusual sadness
• Difficulty swallowing
• Dizziness
• Dizziness when getting up from lying or sitting
• Fast heartbeat
• Fever
• Headache
• Hives
• Increased appetite
• Irregular heartbeat
• Nightmares
• Numbness or tingling in hands, feet, or lips
• Pain around the penis
• Reddening of the skin around the ears
• Redness or swelling of the penis
• Seizures or convulsions
• Shakiness or trembling
• Slurring speech
• Stomach pain
• Sweating
• Swelling of the eyes, face, or inside of the nose
• Vomiting
• Weakness or heaviness of the legs

Other side effects may occur that will not necessitate seeking medical attention. In some cases, these side effects may abate as your body becomes used to the presence of the medications. Your healthcare professional may also be able to help you in alleviating some of the following side effects. If they become bothersome or are ongoing then inform your doctor of the side effects at your next checkup.

Occurring uncommonly:

• Difficulty in passing a stool

Other side effects not listed herein may also occur. In such cases inform your doctor of the side effects and seek medical attention if you are concerned.

Dosage:

These medications should only be used as directed by your doctor. You should never take an increased dose nor take it more frequently than prescribed unless instructed to do so by your doctor.

This medication will come with a guide that you should read and follow. This guide will include advice on healthy eating and exercise. Take these tablets alongside meals to help reduce the effects on your stomach that may occur. After a few weeks of treatment, these side effects should abate and tablets will be able to be taken without food in some cases.

Tablets designed for slow release should be swallowed whole. Do not crush, break or chew these tablets. Do not take broken tablets. Slow release tablets should be taken with the morning meal. Inform your doctor if you begin a diet that is low in sodium.

The most important step in controlling diabetes is following the meal plan as directed by your doctor. This is the best way to control your diabetes and you should follow your doctor’s meal plan closely and exercise regularly as instructed. These steps will help the medicine to work properly.

You will need to carry out regular blood or urine tests to determine sugar levels.

The dose of this medication will vary for each patient and you should follow the dose as directed by your doctor. The following information should be used as a guideline only and you should not make any changes to your dose without consulting your doctor first. The dose you take will depend on a range of factors including your weight and the stage in the development of your condition.

For the treatment of type II diabetes:

• Oral dosage with extended-release tablets

o For patients not receiving Canagliflozin nor Metformin therapy:

• Adults – 2 tablets daily. May be adjusted as required.
• Children – To be determined by the doctor.

o For patients receiving Metformin therapy:

• Adults – 2 tablets daily plus additional Metformin. Should not exceed 2000 mg of Metformin and 300 mg of Canagliflozin daily.
• Children – To be determined by the doctor.

o For patients receiving Canagliflozin therapy:

• Adults – 2 tablets daily plus additional Canagliflozin. Should not exceed 2000 mg of Metformin and 300 mg of Canagliflozin daily.
• Children – To be determined by the doctor.
• Oral dosage with tablets

o For patients not receiving Canagliflozin nor Metformin therapy:

• Adults – 50 mg of Canagliflozin and 500 mg of Metformin taken twice daily. May be adjusted as required.
• Children – To be determined by the doctor.

o For patients receiving Metformin therapy:

• Adults – 50 mg of Canagliflozin taken twice daily in addition to the prescribed dose of Metformin. Should not exceed 2000 mg of Metformin and 300 mg of Canagliflozin daily.
• Children – To be determined by the doctor.

o For patients receiving Canagliflozin therapy:

• Adults – 500 mg of Metformin taken twice daily in addition to the prescribed dose of Canagliflozin. Should not exceed 2000 mg of Metformin and 300 mg of Canagliflozin daily.
• Children – To be determined by the doctor.

If a dose of this medication is missed then it should be taken as soon as possible. If, however, the due time for your next dose is close then you should skip the missed dose completely and return to your usual dosing schedule. Record the date and time of the missed dose so you can share this information with your doctor when you next have a checkup. Never take a double dose of this medication under any circumstances.

Interactions:

Certain medications can interact with one another and can cause serious problems. Medications can react violently with one another and cause severe side effects in the patient. Other medications can prevent one another from working and other medications may intensify the side effects of others. It is vital that you inform your doctor of all medications that you take before taking this subscription. You should inform your doctor of everything you take including vitamin supplements, herbal remedies and over the counter medications.

It is especially important to inform your doctor if you are taking any of the following. This list has been compiled due to the severity of interactions and may not be all-inclusive. Inform your doctor of all medications you are taking.

Use of Canagliflozin and Metformin with the following medications is not recommended. Your doctor may need to change one or more of the medications that you are taking.

• Tyropanoate Sodium
• Metrizoic Acid
• Metrizamide
• Ipodate
• Ioxitalamic Acid
• Ioxaglate
• Ioversol
• Iotroxic Acid
• Iotrolan
• Iothalamate
• Iotasul
• Iosimide
• Ioseric Acid
• Iopronic Acid
• Iopromide
• Iophendylate
• Iopentol
• Iopanoic Acid
• Iopamidol
• Iomeprol
• Iohexol
• Ioglycamic Acid
• Ioglicic Acid
• Iodoxamic Acid
• Iodopyracet
• Iodohippuric Acid
• Iodixanol
• Iodipamide
• Iodamide
• Iocetamic Acid
• Iocarmic Acid
• Iobitridol
• Iobenzamic Acid
• Ethiodized Oil
• Diatrizoate
• Acetrizoic Acid

The use of Canagliflozin and Metformin with the following medications would not be recommended under usual circumstances. The use of both may, however, be the best treatment for you. When prescribing both your doctor may wish to change the dose of one or more medications or change the frequency of which you take them.

• Vandetanib
• Tosufloxacin
• Thioctic Acid
• Sparfloxacin
• Rufloxacin
• Ritonavir
• Prulifloxacin
• Pefloxacin
• Pazufloxacin
• Pasireotide
• Paritaprevir
• Ombitasvir
• Ofloxacin
• Octreotide
• Norfloxacin
• Nadifloxacin
• Moxifloxacin
• Lomefloxacin
• Levofloxacin
• Lanreotide
• Gemifloxacin
• Gatifloxacin
• Flumequine
• Fleroxacin
• Enoxacin
• Dolutegravir
• Dofetilide
• Digoxin
• Dasabuvir
• Ciprofloxacin
• Bupropion
• Besifloxacin
• Balofloxacin
• Aspirin

The use of Canagliflozin and Metformin with the following medications can increase the risk of certain side effects occurring. The use of both medications may, however, still be the best treatment for you. Your doctor may wish to monitor you more closely and may change the dose of medications you receive when using them in conjunction with one another.

• Tranylcypromine
• Timolol
• Sotalol
• Selegiline
• Safinamide
• Rifampin
• Rasagiline
• Ranolazine
• Psyllium
• Propranolol
• Procarbazine
• Practolol
• Pindolol
• Phenelzine
• Penbutolol
• Patiromer
• Oxprenolol
• Nialamide
• Nebivolol
• Nadolol
• Moclobemide
• Metoprolol
• Metipranolol
• Methylene Blue
• Linezolid
• Levobunolol
• Labetalol
• Isocarboxazid
• Iproniazid
• Guar Gum
• Glucomannan
• Furazolidone
• Fenugreek
• Esmolol
• Celiprolol
• Carvedilol
• Carteolol
• Bitter Melon
• Bisoprolol
• Betaxolol
• Atenolol
• Acebutolol

Interactions with other medications may occur. If any side effects occur that you are worried about then you should contact your doctor immediately.

Other medical problems that you have can also impact the use of the combination Canagliflozin and Metformin. You should inform your doctor if you have any other medical conditions and this is particularly important if you suffer from any of the following conditions:

Use with the following conditions can cause a worsening of side effects:

• Underactive adrenal gland
• History of alcohol abuse
• Congestive heart failure
• Severe dehydration
• History of pancreatic insulin deficiency
• Underactive pituitary gland
• Poor nourishment
• Sepsis
• Weakened physical condition

The following conditions may be made worse with this treatment:

• Anemia
• Dehydration
• Genital yeast infection or a history of infections
• Hypercholesteremia
• Hyperkalemia
• Hypotension
• Hypovolemia
• Kidney disease
• History of infections of the urinary tract
• Vitamin B12 deficiency

Patients with the following conditions should not receive this treatment:

• Diabetic ketoacidocis
• Severe kidney disease
• Liver disease
• Metabolic acidosis
• Patients who receive dialysis
• Patients with type I diabetes

The following conditions may cause problems with blood sugar control:

• Fever
• Infection
• Recent surgery
• Recent trauma

Warnings:

Before you begin treatment with Canagliflozin and Metformin you should consider both the benefits and risks with your doctor. In order that your doctor is able to make a correct judgment on whether to prescribe this treatment, they will need to know about all substances that you take, all eating habits that you have, all medical conditions from which you suffer and how much exercise you take. Being honest with your doctor will help them to help you to get better. Before taking this medication you should also consider the following with your doctor:

Allergies – Inform your doctor of any allergies you have had in the past. This includes allergies to medications, dyes, soaps, preservatives, plants, animals and other substances.

Geriatric – Use in the elderly has not been shown to have any limitations. Caution should be taken, however, with other age-related diseases that can affect the use of this treatment. Kidney problems, in particular, can put the patient at greater risk.

Pregnancy – Animal tests have demonstrated an effect on the fetus, but human studies have not been carried out to an adequate level. Discuss use with your doctor before beginning this treatment. If you become pregnant during use then you should inform your doctor immediately. There are also complications that can occur in the development of a fetus in patients who suffer from diabetes. You should discuss pregnancy with your doctor if you think you may like to have children.

Breastfeeding – It is unknown what risks the infant will be exposed to if breastfeeding while using this medication. Discuss this with your doctor before use.

Pediatric – Effective and safe use has not been determined in the pediatric population. Use is to be determined by the doctor.

It is very important that your doctor check up on your progress during use of this medication. This is particularly important during the first few weeks of use. Blood and/or urine tests will need to be taken to check for unwanted effects in the patient.

Your doctor may give you specific instructions about the use of the following. In such cases it is very important that you follow the advice of your doctor, particularly regarding the following:

• Alcohol – The consumption of alcohol can cause your blood sugar level to drop dramatically. Consuming alcohol when you have type II diabetes puts you at significant risk and should be avoided. Discuss alcohol consumption with your doctor to determine safe use.
• Other medications – You should discuss the use of all medications with your doctor before taking. This includes non-prescription medicines and particularly aspirin and medications for appetite control, asthma, hay fever, sinus problems, coughs and colds.
• Counseling

o Patients may need counseling to deal with the lifestyle changes that may need to occur to prevent the worsening of diabetes. Dosing changes may also occur regularly in patients and they will need to be prepared for this.

o Contraception counseling may be required due to the effect that diabetes can have on fetus development.

o Family members of the patient may also need to learn how to prevent side effects and what to do in certain medical situations.

• Travel – When traveling you will need to carry your prescription with you and keep a copy of it at all times. Take time zone changes into account with dosing.
• Emergency identification – Wearing emergency identification and carrying ID in your purse or wallet that tells doctors you are diabetic is an important step to take in case you need emergency medical attention.

The use of metformin puts you at risk of a serious condition call lactic acidosis. If you experience any of the following then you should seek emergency medical attention:

• Abdominal pains
• Loss of appetite
• Diarrhea
• Changed breathing
• Muscle pains
• Cramping
• Unusual sleepiness
• Unusual tiredness
• Unusual weakness

If you experience any more than one of these symptoms at the same time then seek medical attention as an emergency.

You may get dizzy or feel faint when taking this medication. You should assess how it affects you and only operate machinery and equipment that could harm you or others around you, or a car when you are safe to do so and fully alert.

Ketoacidosis can occur when taking this medication. If you experience the following seek emergency help:

• Nausea
• Vomiting
• Troubled breathing
• Increased thirstiness
• Increased urination

Kidney problems can occur with the use of this medication. Tell your doctor if you experience the following signs of a problem:

• Back pain
• Changes to frequency of urination
• Painful urination
• Fever
• Chills
• Swelling of the face, fingers or lower legs

This medication can cause an increase in potassium levels in the blood. Do not take vitamin supplements with this treatment without discussing this with your doctor. This medication may increase your chances of developing infections of the urinary tract. Tell your doctor if you have cloudy urine, difficult urination, painful urination or back pains.

Anaphylaxis can occur when taking this medication. In cases of anaphylaxis, you should seek emergency medical help. Symptoms of anaphylaxis include:

• Skin rash
• Hives
• Welting of the skin
• Itching
• Redness of the skin
• Troubled breathing
• Hives on the:

o Sexual organs

o Lips

o Tongue

o Throat

o Hands

o Legs

o Feet

o Eyelids

o Face

Do not consume large quantities of alcohol with this medication. This will put you at serious risk. Discuss alcohol intake with your doctor.

Hypoglycemia can be caused when you are taking Canagliflozin and Metformin alongside other diabetes medications. In these cases, you must get treatment before you pass out. Everyone will experience the symptoms of low blood sugar levels differently and it is important that you learn to recognize these symptoms so you can treat yourself before you pass out. Talk to your doctor to learn how you can recognize the symptoms and prevent hypoglycemia from occurring and from causing you to lose consciousness.

Hyperglycemia can also occur if you miss a dose of this medication, eat too much sugar, fail to follow your diet plan, miss some exercise or have a fever or infection. If your blood sugar level is too high then you should measure your blood sugar and then contact your doctor so that they can advise you on what to do. Do this is you experience the following symptoms:

• Blurry vision
• Drowsiness
• Dry mouth
• Dry skin
• Fruit-like odor to breath
• Increased urination volume or frequency
• Nausea
• Vomiting
• Deep breathing
• Unusual thirst

Before receiving any further treatment for any other condition you should inform the doctor or dentist that you are taking this medication.

This medicine can affect the results of a wide range of tests that may be carried out on you. If you are undergoing any tests performed by a medical professional then you should inform them that you are undergoing treatment with these medications so that they understand the test readings correctly and are not misled.

Storage:

Always keep this medication out of the reach of children. Do not keep outdated medication for longer than is needed. Dispose of it appropriately as directed by your doctor. Store this medication in a closed container at room temperature. Keep out of direct light, away from moisture and away from heat.

Prevent medication from freezing. Keep the medication in its original packaging until needed to keep them away from moisture. Do not put the tablets in pill boxes or organizers.

Summary:

Canagliflozin and Metformin are used for the treatment of the symptoms of type II diabetes. The combination medicines can be used alone or alongside other medications in order to lower the blood sugar level in a patient suffering from this condition.

The medication works in a twofold manner to combat the high levels of sugar in the blood of a patient with type II diabetes.

Canagliflozin is an inhibitor that prevents glucose from being absorbed into the kidney and as such prevents it from being reintroduced into the bloodstream. This means that glucose is more effectively removed from the blood and the blood sugar level is decreased.

Metformin works to reduce the rate at which sugar can be absorbed from the stomach, reduce the release of sugar into the blood from the liver and increase the body’s ability to use sugar effectively. It also helps the body to respond to insulin allowing for effective insulin treatment to be carried out in combination with this treatment.

The Canagliflozin and Metformin medications are not a cure for type II diabetes. This condition cannot be cured and will worsen over time. The development of this condition will eventually lead to serious medical conditions, but the use of Canagliflozin and Metformin can help to slow this process and prevent development.

Canagliflozin and Metformin must, however, be used alongside effective changes in lifestyle to assist in the reduction of sugar in the blood. This medication should always be prescribed alongside lifestyle and health advice that will enable the patient to prevent the development of the condition. This advice will include weight loss tips, healthy eating advice, sugar reduction advice, exercise advice and other steps that can be taken to live a healthier life.

The consumption of alcohol when being treated for type II diabetes and when taking Canagliflozin and Metformin can put you at serious risk. Alcohol can significantly lower the level of sugar in the blood and in doing so can put the patient at risk of experiencing hypoglycemia.

There is a significant potential that sufferers of type II diabetes will need to receive emergency medical attention at some point. It is important to wear some identification that tells the medical professionals that you have type II diabetes and carry such ID in your wallet or purse too. This will enable them to recognize your condition and give you effective treatment. Treatments given in other cases of medical emergency can make your condition worse so it is important that they are able to identify your medical condition before giving you any treatment. It is highly likely that you will be unconscious and unable to inform them verbally at this point.