Look inside the book: Nursing 2025-2026 Drug Handbook

216 canagliflozin

serious necrotizing fasciitis of the perineum (Fournier gangrene). If necrotizing fasci itis is suspected, immediately discontinue SGL2 drug and begin broad-spectrum antibi otics. Surgical debridement may be necessary. Monitor blood glucose level and start alter native therapy for glycemic control. Serious outcomes have included hospitalization, mul tiple surgeries, and death. • Drug increases serum creatinine level and decreases eGFR; patients with hypovolemia may be more susceptible to these changes. Kidney function abnormalities can occur after drug initiation. More frequent kidney function monitoring is recommended in patients with an eGFR of less than 60 mL/minute/1.73 m 2 . • Use cautiously in older adults; in patients with volume depletion, impaired kidney func tion, chronic low systolic BP, or hypotension; and in those on concurrent diuretics. • Safety and effectiveness in children haven’t been established. • Dialyzable drug: No. PREGNANCY-LACTATION-REPRODUCTION • Studies during pregnancy are inadequate. Use during pregnancy only if potential benefit justifies fetal risk. • Due to adverse effects on kidney de velopment seen in animal studies, use of canagliflozin during second and third trimesters isn’t recommended. • It isn’t known if drug appears in human milk. Due to potential for serious adverse reactions in the infant, use of drug during breastfeeding isn’t recommended. NURSING CONSIDERATIONS • Monitor patient for infections, new pain or tenderness, and sores or ulcers of the lower limbs. Discontinue drug if these complica tions occur. Alert: Drug can increase risk of AKI. Be fore start of therapy, assess for factors that may predispose patient to AKI (decreased blood volume, CKD, HF, or concurrent use of other medications [diuretics, ACE inhibitors, metformin, ARBs, NSAIDs]). Assess kidney function before starting drug and monitor pa tient periodically. If AKI occurs, discontinue drug and treat kidney impairment. • Correct volume depletion before initiating drug. Observe for hypotension during therapy. Alert: Monitor patient for ketoacidosis, especially with major illness, reduced food or

fluid intake, or reduced insulin dose. Elevated urine or serum ketone levels without associ ated very high glucose levels have occurred with SGLT2 inhibitor use. Alert: Immediately report signs and symp toms of necrotizing fasciitis of the perineum (temperature above 100.4 ◦ F[38 ◦ C]); gen eral feeling of unwellness; tenderness, red ness, or swelling of area from genitals to rectum). Signs and symptoms can worsen quickly. Immediately stop drug and prepare to administer broad-spectrum antibiotics; sur gical debridement may be necessary. Monitor blood glucose level and start alternative ther apy for glycemic control. • Monitor blood glucose level. Assess for signs and symptoms of hypoglycemia. • Be aware that because of drug’s mechanism of action, urine test will be positive for glucose. • Drug may increase lipid levels. Assess levels periodically and treat as clinically indicated. • Assess for genital mycotic (fungal) infec tions, especially in patient with a history of infection and in uncircumcised male. Treat appropriately. • Monitor patient for hypersensitivity reac tion (urticaria); reaction may occur hours to days after start of therapy. Discontinue drug and treat appropriately if hypersensitivity re action occurs. PATIENT TEACHING • Counsel patient about increased risk of lower limb amputations. Explain importance of routine preventive foot care, and instruct patient to immediately report infections, new pain or tenderness, and sores or ulcers involv ing the lower limbs. • Advise patient to discontinue drug and im mediately report hypersensitivity reaction (generalized urticarial rash). Alert: Teach about signs and symptoms of necrotizing fasciitis (temperature above 100.4 ◦ F[38 ◦ C]; general feeling of unwell ness; and tenderness, redness, or swelling of area from genitals to rectum). Instruct patient to seek immediate medical attention if any occur. Alert: Advise patient to seek immediate med ical attention for signs and symptoms of ke toacidosis (difficulty breathing, hyperventila tion, anorexia, nausea, vomiting, abdominal pain, confusion, unusual fatigue or sleepiness). Alert: Instruct patient to seek medical attention for signs and symptoms of UTI

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Reactions in bold italics are life-threatening .