Look inside the book: Nursing 2025-2026 Drug Handbook

214 canagliflozin

NURSING CONSIDERATIONS Alert: Double-check that you’re giving the correct form of calcium; resuscitation cart may contain both calcium gluconate and cal cium chloride. • Monitor calcium level frequently. Hyper calcemia may result after large doses in KF. Report abnormalities. • Signs and symptoms of severe hypercal cemia include stupor, confusion, delirium, and coma. Signs and symptoms of mild hy percalcemia include anorexia, nausea, and vomiting. • Look alike–sound alike: Don’t confuse cal cium with calcitriol. Don’t confuse calcium chloride with calcium gluconate. PATIENT TEACHING • Tell patient to take oral calcium 1 to 1 1 ⁄ 2 hours after meals if GI upset occurs. • Instruct patient to take oral calcium with a full glass of water. • Teach patient to report anorexia, nausea, vomiting, constipation, abdominal pain, dry mouth, thirst, or polyuria. • Advise patient to notify prescriber if taking OTC products such as iron. • Warn patient not to eat rhubarb, spinach, bran or whole-grain cereals, and dairy prod ucts in the meal before taking calcium; these foods may interfere with calcium absorption. • Inform patient that some products may con tain phenylalanine or tartrazine. canagliflozin kan-a-gli-FLOE-zin Invokana Therapeutic class: Antidiabetics Pharmacologic class: Sodium-glucose cotransporter 2 inhibitors SAFETY ALERT!

Levothyroxine: May decrease effects of thy roid products. Separate by at least 4 hours. Raltegravir: May decrease raltegravir serum level. Give raltegravir 2 hours before or 6 hours after calcium or avoid use together. Sodium polystyrene sulfonate: Maycause metabolic acidosis in patients with kidney disease and a reduction of the resin’s bind ing of potassium. Separate drugs by several hours. Tetracyclines: May decrease serum level of tetracyclines. Avoid use together or, if use to gether can’t be avoided, consider separating administration of each agent by several hours. Thiazide diuretics: May cause hypercalcemia. Avoid use together. Drug-food. Foods containing oxalic acid (rhubarb, spinach), phytic acid (bran, whole grain cereals), or phosphorus (dairy prod ucts, milk): May interfere with calcium ab sorption. Discourage use together. EFFECTS ON LAB TEST RESULTS • May increase calcium level. • May decrease phosphorus level. CONTRAINDICATIONS & CAUTIONS • Contraindicated in those with ventricular fibrillation, existing digoxin toxicity, or hy percalcemia. • Use calcium products with extreme caution in patients taking cardiac glycosides and in those with cancer who have bone metastases, sarcoidosis, kidney or cardiac disease, kidney stones, or electrolyte disturbances, including hyperphosphatemia hypokalemia and hypo magnesemia. • Use calcium chloride cautiously in patients with cor pulmonale, respiratory acidosis, or respiratory failure. • Dialyzable drug: Yes. • H Overdose S&S: Hypercalcemia, confusion, delirium, stupor, coma. PREGNANCY-LACTATION-REPRODUCTION • It isn’t known if drug causes fetal harm when used during pregnancy or if it affects reproductive capacity. Use during pregnancy only if clearly needed; monitor serum calcium level. • Calcium appears in human milk but is thought to be compatible with breast feeding. Monitor patient serum calcium level.


Adjust-a-dose (for all indications): Refer to manufacturer’s instructions for use in patients with kidney impairment and drug interaction dosage adjustments. ➤ Adjunct to diet and exercise to improve glycemic control in patients with type 2

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