Look inside the book: Nursing 2025-2026 Drug Handbook

canagliflozin 215

diabetes; to reduce risk of major adverse CV events in patients with type 2 diabetes and established CV disease Adults: 100 mg PO once daily before first meal of the day. May increase to 300 mg/day. ➤ To reduce risk of CKD, doubling of serum creatinine level, CV death, and hos pitalization for HF in patients with type 2 diabetes and diabetic nephropathy with albuminuria greater than 300 mg/day Adults: 100 mg PO once daily. May increase to 300 mg/day only in patients with eGFR 60 mL/minute/1.73 m 2 or greater. ADMINISTRATION PO • Give before first meal of the day. • Give missed dose as soon as possible unless it’s close to time of next regularly scheduled dose. Don’t give two doses at the same time. • Store tablets at room temperature. ACTION Inhibits SGLT2, which reabsorbs glucose fil tered by the kidneys, increasing urinary glu cose excretion. Route Onset Peak Duration PO Unknown 1–2 hr Unknown Half-life: 10.6 hours for 100-mg dose; 13.1 hours for 300-mg dose. ADVERSE REACTIONS CNS: fatigue, asthenia, syncope, postural dizziness. CV: hypotension, orthostatic hy potension. GI: thirst, constipation, nausea, abdominal pain, dehydration, pancreatitis. GU: genital fungal infection, UTI, increased urination, vulvovaginal pruritus, kidney im pairment. Hematologic: increased Hb level. Metabolic: hypoglycemia, hyperkalemia, hypercholesterolemia, hyperphosphatemia. Musculoskeletal: bone fracture, increased risk of lower limb amputation. Other: hyper sensitivity reactions, falls. INTERACTIONS Drug-drug. Digoxin: May increase digoxin level. Monitor digoxin level periodically. Fosphenytoin, phenytoin: May decrease canagliflozin level. Consider increasing canagliflozin to 200 mg/day in patients tol erating 100 mg/day and to 300 mg/day in pa tients with eGFR of 60 mL/minute/1.73 m 2 or greater.

Insulin and insulin secretagogues (glipizide, repaglinide): May increase risk of hypo glycemia. Consider lower dosage of insulin or insulin secretagogue. Lithium: May decrease lithium level. Monitor level more frequently during canagliflozin initiation and dosage change. Salicylates: May increase hypoglycemic ef fects. Monitor patient closely. SSRIs (citalopram, fluoxetine, sertraline): May increase canagliflozin level. Monitor pa tient closely. Canagliflozin dosage may need adjustment if SSRI is discontinued. UGT inducers (phenobarbital, rifampin, ri tonavir): May decrease canagliflozin level. Adjust canagliflozin dosage based on esti matedGFR. Drug-herb. St. John’s wort: May decrease canagliflozin level. Consider increasing canagliflozin dosage based on GFR. EFFECTS ON LAB TEST RESULTS • May increase serum creatinine, potassium, phosphate, Hb, LDL-C, non-HDL-C, and urine glucose levels. • May decrease GFR and serum glucose level. • May cause positive test for glycosuria and interfere with 1,5-anhydroglucitol assay. Use other methods to monitor glycemic control. CONTRAINDICATIONS & CAUTIONS • Contraindicated in patients with serious hypersensitivity to drug or its components. • Contraindicated in patients with eGFR of less than 30 mL/minute/1.73 m 2 . • Drug isn’t recommended for patients with Child-Pugh class C liver impairment, type 1 diabetes, or diabetic ketoacidosis. • For patients who will undergo scheduled surgery, consider temporarily stopping drug for at least 3 days before surgery. Alert: Drug may cause acidosis, which may require emergency department care or hospi talization. Temporarily stop drug and resolve ketoacidosis before restarting drug. • Drug may increase risk of bone fracture as early as 12 weeks after start of treatment and has been linked to decreased bone mineral density. Consider factors that may contribute to bone fracture risk prior to prescribing. Alert: Drug may increase risk of severe UTI, including urosepsis and pyelonephritis. Moni tor patient and treat promptly if indicated. Alert: SGLT2 inhibitors such as canagliflozin increase the risk of a rare but


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