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standing up) to your healthcare team.
Be cautious about driving or operating
machinery until you know how
your body responds to canagliflozin
Seek urgent medical attention if you
experience an allergic reaction, which
may be serious (rash, hives, swelling of
the lips, tongue and throat, difficulty in
Take preventive measures against
genital fungal infections and urinary
tract infections, especially if you have
had a prior history of these infections.
If you are pregnant or become
pregnant, canagliflozin might be
harmful to the baby and should not be
taken. Speak with your doctor about
using canagliflozin in pregnancy or
SGLT2 inhibitors such as canagliflozin
are promising additions to the range of
therapeutic options for the management
of glycaemic control in type 2 diabetes,
especially considering their favourable
effects on body weight and blood
pressure. However, more long‐term data
are required to better establish its place
in therapy. Meanwhile, patient education
and monitoring are important to mitigate
the risks for adverse events and optimise
the use of these medications.
KEY LEARNING POINTS
• Canagliflozin is indicated as
monotherapy in patients who cannot
receive metformin and for whom diet
and exercise alone do not provide
adequate glycaemic control, and as
add‐on combination therapy with
other antihyperglycaemic agents.
However, it is PBS‐listed only for use
as dual therapy with either metformin
or a sulphonylurea in patients who are
not able to be adequately controlled
with metformin plus a sulphonylurea.
• Canagliflozin provides effective
glycaemic control and is associated
with modest decreases in weight loss
and blood pressure.
The recommended dose of canagliflozin
is 100 mg or 300 mg once daily in adults
with type 2 diabetes. Patients for whom
the lower dose of 100 mg should be
initiated are those taking loop diuretics
and those age 75 years and over. Patients
with CKD Stage 3a renal impairment
(eGFR 45 to 59 mL/min/1.73m2 or CrCl
45 to 59 mL/min) should be limited to
the 100 mg dose.
• Patients on canagliflozin should be
counselled on preventing adverse
effects such as dehydration, genital
fungal infections and urinary tract
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3. UKPDS Working Group. Implications of the United
Kingdom prospective diabetes study. Diabetes Care
4. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of
type 2 glycaemia in type 2 diabetes: A patient-centered
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6. Gehrich JE. Role of the kidney in normal glucose
homeostasis and in the hyperglycaemia of diabetes mellitus:
therapeutic implications. Diabet Med 2010;27:136–42.
7. Rothenberg PL et al. Poster presented at the 46th
European Association for the Study of Diabetes Annual
Meeting; 20–24 Sep 2010, Stockholm, Sweden.
8. Stenlöf K, Cefalu WT, Kim KA, et al. Efficacy and safety
of canagliflozin monotherapy in subjects with type 2
diabetes mellitus inadequately controlled with diet and
exercise. Diabetes Obes Metab 2012;15:372–82.
9. Rosenstock J, Aggarwal N, Polidori D, et al. Dose-ranging
effects of canagliflozin, a sodium-glucose cotransporter 2
inhibitor, as add-on to metformin in subjects with type 2
diabetes. Diabetes Care 2012;35:1232–8 .
10. Blonde L, Wilding J, Chiasson J-L, et al. Canagliflozin lowers
A1C and blood pressure through weight loss-independent
and weight loss-associated mechanisms. Poster presented
at the 73rd American Diabetes Association. 21–25 Jun
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11. INVOKANA Australian Approved Product Information,
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of canagliflozin versus glimepiride in patients with type
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compared with sitagliptin for patients with type 2
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treat type 2 diabetes [news release]. Mar 29 2013. At: www.
ucm345848.htm. (Accessed 24 Dec 2013.)
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(Accessed 24 Dec 2013.)
1. Which of the following is the
recommended dose of canagliflozin
in patients with a eGFR of 45 to <60
mL/min/1.73m2 or CrCl of 45 to <60
a) 50 mg.
b) 100 mg.
c) 200 mg.
d) 300 mg.
2. Canagliflozin has been shown to
lower all of the following except:
a) Blood glucose.
b) Systolic blood pressure.
c) Body weight.
d) HDL cholesterol.
3. Which of the following statements is
a) Canagliflozin has a low risk of
hypoglycaemia when used as
b) Canagliflozin stimulates insulin release.
c) Canagliflozin has a low risk of
hypoglycaemia when combined with
d) Canagliflozin has an increased risk of
hypoglycaemia over placebo when
combined with a sulphonylurea.
4. Which of the following statements is
a) The efficacy of canagliflozin is
dependent on renal function.
b) Canagliflozin decreases renal
reabsorption of glucose.
c) Urinary glucose excretion induced
by canagliflozin leads to an osmotic
diuresis, which can be associated with
caloric loss, and reductions in weight
and blood pressure.
d) All of the above.
5. The main side effects reported with
a) Genital mycotic infection.
b) Weight gain.
d) Upper respiratory tract infection.
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