Canagliflozin (Oral)

Canagliflozin is taken orally and works by acting on the kidney to prevent it absorbing excess glucose.

Overview

Canagliflozin is a prescription-only medication that is used to control blood sugar levels in those with type 2 diabetes. The medication works by acting on the kidney to prevent the absorption of blood sugar (glucose). Preventing glucose from being absorbed then lowers blood sugar levels in patients.

High blood sugar levels occur when the body stops maintaining its normal, natural glucose levels. This happens as a result of the pancreas not producing enough insulin, or because the body's cells have become too resistant to insulin. The condition can make a patient feel tired, lethargic and often nauseous. As blood containing high sugar levels deposits more sugar in the kidneys and bladder, it can also lead to a more frequent need to urinate, as well as increased thirst, even if you drink enough water.

If a patient's blood sugar levels are left at a high level for a long period of time, this may cause permanent damage to various parts of the body, in particular, the kidneys, nerves, blood vessels and eyes. Blood sugar levels can usually be lowered by medication such as canagliflozin, and by making certain lifestyle and dietary changes. This drug will, as a result, often be recommended along with diet plans and changes to the lifestyle of the patient, as part of a long-term, holistic treatment for the condition.

This drug is not used to treat patients that have type 1 diabetes that have insulin-dependent diabetes. These patients need instead to use insulin injections.

Canagliflozin is also marketed and sold under its brand name Invokana in pharmacies throughout the United States. The drug is available in a tablet form, to be taken by patients orally.

Conditions treated

  • High blood sugar levels (high glucose)

Type of medicine

  • Tablet

Side effects

There are various side effects that patients taking canagliflozin can expect. However, many people will be able to take the drug without experiencing any negative impact. Many of the more common side effects of the drug are considered normal and are usually not a cause to worry. Often, common and minor side effects will be worth the health benefits they return.

You should always ask a health care professional for advice if you are worried about any changes to your physical and mental wellbeing following a treatment of canagliflozin. There are some side effects that can be particularly uncomfortable or can lead to health complications, so you may need to stop your treatment immediately if you experience any symptoms. Below are the common side effects:

skin sensitivity to being in the sun; sunburn or heat rash

hypersensitivity reactions, such as redness, swelling, hives and skin rashes

  • bone fractures
  • 400;">constipation
  • 400;">diarrhea
  • nausea or vomiting
  • increased urination, or need to go more frequently
  • yeast infections, such as cystitis
  • kidney issues
  • urinary tract infections,
  • vaginal itching, leading to conditions such as thrush
  • unusual thirstiness
  • fatigue, exhaustion and general tiredness
  • feeling of weakness or faintness
  • aching muscles

Always tell your doctor if you are experiencing any of the rarer side effects listed below. These may be signs of a serious health condition, and you may require urgent treatment:

  • confusion or disorientation
  • cool, pale skin, often a blue color in tone
  • 400;">depression or mood swings
  • anxiety or fear
  • poor or blurry vision
  • chills in any part of the body
  • cold sweating
  • infections in the private parts, such as swelling, hives, rashes
  • nightmares or disturbed sleep patterns
  • 400;">dizziness or feeling like you are going to faint
  • shakiness in movements
  • slurred speech or difficulty forming sentences
  • redness or blotchiness of the skin
  • faster heartbeat than normal
  • irregular heartbeat
  • 400;">headache
  • dry mouth or tongue
  • unusual levels of hunger; feeling like you are not full even after eating a full dinner
  • seizures and fits
  • unusual tiredness or weakness
  • Difficulty passing a bowel movement
  • Sudden loss of strength in the arms or legs
  • pain or swelling in the arms or legs without any known cause

Dosage

The dose that is prescribed to you will be highly individual towards your personal medical history and other circumstances. Do not attempt to alter your dose, and do not attempt to stop it without medical advice.

The usual dosage of this medication is 100 mg taken once per day. You should take each dose at the same time during each day, ideally before the first meal of the day. It is important to take it before meals as the food you consume afterwards will help your body to digest and absorb the medication, while minimising side effects that you may experience.

Once your toleration for the medication has been assessed, your doctor may decide to increase your dosage to up to 300 mg per day.

Major drug interactions

The reason your doctor will always ask you what other medications you are taking is so that he or she can safely prescribe you something suitable for your medical history. There are some drugs that react with others so, if you are taking a drug already, you need to be sure that canagliflozin will not react with it inside your body. A drug reaction can cause severe and even unknown side effects, which can be very dangerous.

Although there are more than 700 drugs that cause an interaction with canagliflozin, there are currently only a few that have been found to have a major reaction. One of those drugs is gatifloxacin, also known by its brand names Tequin and Tequin Teqpaq. If you are taking this drug, you should tell your doctor immediately, as it should not be mixed with canagliflozin on any occasions.

You should also not take canagliflozin if you are taking rifampin or digoxin as this again can create unwanted and potentially dangerous side effects.

Some drugs that have some level of reaction with this one are listed below:

  • acetic acid, desonide otic
  • acyclovir, hydrocortisone topical
  • alclometasone topical
  • aloe vera, hydrocortisone, iodoquinol topical
  • amcinonide topical
  • ammonium lactate, halobetasol topical
  • ammonium lactate, mometasone topical
  • bacitracin, hydrocortisone, neomycin, polymyxin b topical
  • benzoyl peroxide, hydrocortisone topical
  • betamethasone topical
  • betamethasone, calcipotriene topical
  • betamethasone, clotrimazole topical
  • chlorcyclizine, hydrocortisone topical
  • clioquinol, hydrocortisone topical
  • clioquinol, hydrocortisone, pramoxine topical
  • clobetasol topical
  • clobetasol, coal tar topical
  • clocortolone topical
  • desonide topical
  • desoximetasone topical
  • dexamethasone topical
  • dexamethasone, neomycin topical
  • diflorasone topical
  • diosmiplex, hydrocortisone, pramoxine topical
  • diphenhydramine, hydrocortisone topical
  • diphenhydramine, hydrocortisone, nystatin topical
  • diphenhydramine, hydrocortisone, nystatin, tetracycline topical
  • fluocinolone topical
  • fluocinolone, hydroquinone, tretinoin topical
  • fluocinolone, neomycin topical
  • fluocinonide topical
  • flurandrenolide topical
  • fluticasone topical
  • halcinonide topical
  • halobetasol topical
  • hydrocortisone topical
  • hydrocortisone, iodoquinol topical
  • hydrocortisone, ketoconazole topical
  • hydrocortisone, lidocaine topical
  • hydrocortisone, lidocaine, psyllium topical
  • hydrocortisone, neomycin topical
  • hydrocortisone, neomycin, polymyxin b topical
  • hydrocortisone, pramoxine topical
  • hydrocortisone, salicylic acid, sulfur topical
  • hydrocortisone, urea topical
  • methylprednisolone topical
  • methylprednisolone, neomycin topical
  • mometasone topical
  • nystatin, triamcinolone topical
  • prednicarbate topical
  • triamcinolone topical

Warnings

Musculoskeletal risks and lower limb amputation risks

There has been a recent medical trial that took place over a large number of years, studying the possible risk of limb amputation in those that were taking this medication. A placebo group and a group taking canagliflozin were studied and it was found that the number of amputations per 1,000 patients was higher in the medication group than it was in the placebo group. There were 5.8 amputations per 1,000 in the canagliflozin group, compared with 2.8 amputations in the placebo group. Most of the amputations were of the toe and midfoot area; however, there were some amputations that took place of the leg, both below and above the knee. Lower limb amputations have therefore been declared a Ĺ“common risk or side effect from taking this drug (occurring in around 1 percent to 10 percent of patients).

There has also been a recent medical study that has found that there is an increased risk of bone mineral density and bone fracture among patients that are taking canagliflozin. These fractures have occurred as a result of fairly minor traumas. The study, carried out by the United States Food and Drug Administration, declared bone fractures to be a rare side effect of this drug, occurring in around 0.1 percent to 1 percent of patients.

Allergies

Your doctor will also need to know if you have any allergies to other medications, to pets such as cats and dogs, to pollen or to any type of food or preservative. Make sure you are upfront about your allergies it is in the interest of your safety and may affect the type of amount of prescriptive drug that is available to you.

Other conditions and illnesses

There are certain drugs that will interact with this drug, and likewise, there are other diseases and conditions that react with it. Your doctor will likely have details of your medical history on file already, but you should also make sure you tell him or her if you think you may be suffering or may have suffered from other conditions in the past. There are four diseases that can cause a major interaction with canagliflozin and can cause the medication not to work, or can cause your conditions to worsen. Side effects and their consequences can be highly dangerous. These diseases are:

Female patients

There has been found to be an increased risk to female patients taking this medication of contracting a type of urinary tract infection, such as vaginal infection, vulvitis, vulvovaginal mycotic infection, vulvovaginitis, and genital infection fungal (up to 11.4 percent). These infections can take place in male patients as well, with 22 percent said to have experienced recurrent male genital mycotic infections.

Alcohol and lifestyle interactions

It is not advisable to consume any products that contain alcohol (ethanol) while you are taking this medication. This is because alcohol can affect the levels of glucose in the body, and can negate the impact of your prescription drug. If you have not got your diabetes under good enough control, you should avoid alcohol completely, not only while taking this drug but also in general to treat your condition.

If your diabetes is under better control, you may be able to take small amounts of alcohol. This is usually limited to one drink per day for women and two drinks per day for men.

If you suffer from neuropathy (nerve damage), triglycerides or pancreatitis, you should also refrain from alcohol use during this treatment. Alcohol can make your condition worse and can stop your drugs from working properly. You may experience heightened side effects of this drug if you drink alcohol at the same time. You may also be more vulnerable to the effects of alcohol while you are taking this medication; you will find it easier to experience slurring speech, headaches, nausea, vomiting, disorientation, lack of judgement, dizziness and faintness.

Missed doses

Your medication will be more effective if you stick to all the dosage instructions that your doctor will have provided. If you miss a dose, however, it is unlikely to have much of an impact on your treatment; just take it when you remember or move straight on to the next dose. Contact your doctor if you think you may have missed more than one dose.

Pregnancy and breastfeeding mothers

This medication will not normally be prescribed to a pregnant woman. This is because there have been studies in animals to suggest that the drug may cause harm to an unborn fetus, resulting in birth defects, abnormalities and even death. Occasionally, the doctor may deem the benefits of taking the drug to outweigh the risks to an unborn baby, and then it may still be prescribed.

The same theory applies to mothers breastfeeding their babies. The medication is not generally recommended, as there have been studies to suggest that the drug may enter the breast milk, but there may well be cases where the mother's health may be at serious risk without taking the treatment.

Storage

You should always take good care to store this medication properly, to ensure that it remains as effective as it can be, while also making sure it is out of the reach of those for whom it is not intended. Your prescription will usually come in a lockable, child-proof container. Once this lid is shut, it is practically impossible for children to open the lid, thus rapidly reducing the risk of the drugs being consumed by children.

There are more than 60,000 cases in the United States of children being admitted to emergency rooms because of prescription medications that they have mistakenly consumed. Do not let your child become one of these statistics; always keep your prescription medication in lockable containers in a tamper-proof medical cabinet.

Disposal

If you reach the end of your course of treatment and you find that there are tablets left over that you no longer need, you should throw them away safely and responsibly. The FDA has set up specific schemes to collect unwanted and expired medications from both individuals and businesses. This is the safest and most convenient way for you to get rid of your prescription. You can visit the FDA's website to find out more about the schemes that are available where you live, or to read about how you can safely dispose of medicines yourself while minimising the risk of consumption by children and animals.

Summary

Canagliflozin is an effective medication for treating high blood sugar levels and, if taken correctly, can be a safe treatment for the majority of type two diabetes sufferers. There have been several recent studies that have caused concern among those taking this medication, finding an increased risk of lower limb amputation and bone marrow density. However, it is important to note that these side effects are still very rare, and the health benefits will still be found to outweigh the risks in many cases.

Patients can minimise the risk of developing serious side effects by telling their doctors their full medical history before receiving their prescriptions. Patients should also be mindful to mention any other diseases or illnesses they have suffered from in the past, as well as any health problems they currently have. The same applies to allergies always tell your doctor if you have experienced allergies to cat or dogs, other medications, pollen or foods. The more information you tell your doctor at the start, the more chance you will have of being able to take canagliflozin without any unpleasant side effects.

Canagliflozin is most effective when it is taken in accordance with the dosage instructions patients will have been given. They should not attempt to alter their dosages but should speak to a doctor if they think the dosage should be increased or decreased. Missed doses do not have much impact unless they are frequently missed.

Canagliflozin does not react with a large number of drugs and therefore remains a popular choice for treating high blood sugar levels in those with type two diabetes. These patients are often on a number of other medications, and therefore there are many other medications that treat high blood sugar levels that may be unsuitable. This drug is safe to use for the majority of people. It also has been found to drastically improve the quality of life for many of the disease's sufferers, helping them to maintain healthy levels of blood sugar, and therefore decrease unpleasant symptoms of the condition.

This medication is not intended as a long-term or sole solution to lowering blood sugar levels in patients with type two diabetes. Patients with this condition will need to make significant lifestyle changes in order to improve their conditions. Doctors will often be able to recommend lifestyle and diet changes to initiate alongside a course of canagliflozin. The drug will be a lot more effective if these lifestyle and healthy eating commitments are made by the patient.