Canagliflozin

Canagliflozin is an oral medication in the class of sodium-glucose co-transporter 2 (SGLT2) inhibitors used to improve glycemic control in adults with type 2 diabetes. It lowers blood glucose by blocking SGLT2 in the proximal tubules of the kidney, reducing reabsorption of filtered glucose and increasing urinary glucose excretion. The drug can also contribute to modest weight loss and a small reduction in blood pressure.

Canagliflozin is indicated as an adjunct to diet and exercise for adults with type 2 diabetes to improve glycemic control, and it can be used as monotherapy or in combination with other antidiabetic agents, including insulin. Some patients may experience cardiovascular or renal benefits with this class of medication, particularly those at high cardiovascular risk. It is not indicated for type 1 diabetes or for treatment of diabetic ketoacidosis. Efficacy tends to diminish with decreasing kidney function, so kidney status influences its use.

The medication is available as 100 mg and 300 mg tablets, taken once daily with or without food. Dosing is adjusted based on kidney function. Canagliflozin is absorbed orally and is metabolized primarily by glucuronidation, with elimination via urine and feces.

Common adverse effects include genital yeast infections, urinary tract infections, and increased urination. It can cause volume depletion, leading to dehydration and orthostatic symptoms. Serious but rare risks include euglycemic diabetic ketoacidosis, acute kidney injury, hypotension, and an increased risk of lower-limb amputations observed in some patients. Caution is advised in individuals with kidney disease, dehydration, or a history of amputation. Canagliflozin was approved by the U.S. FDA in 2013 and is marketed under the brand Invokana by Janssen Pharmaceuticals.