Canagliflozin-based medicines can only be dispensed on presentation of a limited repeatable prescription or RRL (drugs that can be sold to the public only on prescription from hospitals or specialists). Being classified as group A drugs, they can be supplied by the National Health System (NHS).
Examples of Medicines containing Canagliflozin
- Invokana®
- Vokanamet® (in combination with metformin)
Note: in this article we will consider indications, warnings, interactions, side effects, use in pregnancy and during lactation and contraindications of canagliflozin alone and not of canagliflozin in combination with other antidiabetics.
type 2, either alone or in combination with other antidiabetic drugs, such as:
- Metformin;
- Insulin;
- Dipeptidyl-peptidase 4 inhibitors (sitagliptin, saxagliptin, linagliptin, etc.);
- Pioglitazone;
- Sulfonylureas (glipizide, glimepiride, etc.).
Please Note
In addition to drug therapy, the doctor will also prescribe a "special diet (normoglycemic) and the execution of a regular physical activity. Dietary treatment and physical exercise must NOT be interrupted when starting therapy with antidiabetic drugs. In fact, the latter must be associated with a normoglycemic diet and regular motor activity and not be used as an alternative to them.
;In any case, it is necessary to inform the doctor of one's health conditions, making him aware of the possible presence of ailments or diseases of any kind, even if not listed in the above list.
During treatment with canagliflozin, however, the doctor should be informed immediately if:
- Diabetic ketoacidosis occurs, characterized by symptoms such as:
- Increased levels of ketone bodies in the urine or blood
- Rapid weight loss;
- Nausea or vomiting
- Stomach pain
- Excessive thirst
- Fast, deep breathing;
- Confusion;
- Unusual sleepiness or tiredness
- Sweet smell of breath;
- Sweet or metallic taste in the mouth;
- Change in the smell of urine or sweat.
Note: The risk of developing diabetic ketoacidosis increases in case of: prolonged fasting, excessive alcohol consumption, dehydration, sudden reduction in insulin dose or an increased need for insulin dose following major surgery or serious illness.
- There are signs of genital infection, such as itching, irritation, discharge and unusual odor.
Furthermore, during treatment with canagliflozin, it is very important to check your feet and follow the advice given by your doctor regarding their care, hygiene and hydration.
Please Note
- The use of canagliflozin is not recommended in children and adolescents less than 18 years of age.
- Due to the mechanism of action with which canagliflozin acts (see dedicated chapter), the urine of patients treated with the active ingredient will be positive for sugars.
- Cases of dizziness which may impair the ability to drive and / or use machines have been reported during treatment with canagliflozin. Furthermore, when canagliflozin is used in combination with other antidiabetic drugs, there is an increased risk of developing hypoglycaemia, the symptoms of which may alter the aforementioned abilities.
In any case, before you start taking canagliflozin, you should tell your doctor if you are taking, or have recently been taking, any medications or products of any kind - even if not listed above - including medications without " medical prescription obligation (SOP), over-the-counter medicines (OTC), herbal and phytotherapeutic products and homeopathic products.
experiencing undesirable effects that differ in type and intensity, or not showing them at all.
Treatment should be stopped immediately and the doctor immediately alerted if the following serious side effects appear:
- Severe allergic reactions which can occur with swelling of the face, lips, throat and tongue resulting in difficulty breathing and swallowing.
- Diabetic ketoacidosis (symptoms are described in the "Warnings and Precautions" chapter).
- Dehydration, a condition that can occur mainly in patients over 75 years of age, in patients with kidney problems and in patients taking diuretics. Dehydration is characterized by the following signs:
- Dizziness
- Fainting
- Very dry mouth;
- Elevated feeling of thirst;
- Weakness and fatigue;
- Reduced or no urinary excretion;
- Tachycardia.
- Hypoglycaemia, common when canagliflozin is taken in combination with other antidiabetic drugs. Hypoglycemia can manifest itself with various signs and symptoms; these include:
- Blurred vision
- Tremors
- Sweating;
- Pallor;
- Tingling sensation in the lips;
- Anxiety and confusion.
The doctor must provide the patient with all the necessary information on how to deal with a possible hypoglycemic attack.
Very common side effects
Among the very common and common side effects that could occur during canagliflozin therapy, we find:
- Genital yeast infections (vaginal, penile and foreskin);
- Urinary tract infections;
- Changes in the frequency of urination and the volume of urine excreted;
- Constipation;
- Thirst;
- Nausea;
- Changes in blood fat levels and changes in hematocrit.
Uncommon side effects
Among the uncommon side effects that can occur during therapy with canagliflozin, however, we find:
- Redness of the skin and rashes;
- Urticaria;
- Kidney failure;
- Changes in blood levels of creatinine or urea
- Increase in blood potassium levels;
- Increased levels of phosphate in the blood;
- Phimosis;
- Amputations of the lower limbs, in particular, of the toes, especially if you are at high risk of cardiovascular disease.
Overdose
In the event of an overdose of canagliflozin - known or suspected - it is necessary to contact your doctor immediately, or go to the nearest emergency room, taking care to take the package of the medicine taken with you.
The patient should receive appropriate supportive treatment and appropriate clinical monitoring instituted.
- type 2 glucose (SGLT-2) localized in the kidney.This transporter is primarily responsible for the reabsorption of filtered glucose from the tubular lumen. Patients with type 2 diabetes have high glucose reabsorption in the kidneys even if hyperglycemia is present.
Canagliflozin, by inhibiting SGLT-2, reduces the reabsorption of glucose thus favoring its urinary excretion (increase in glycosuria). In this way, there is a lowering of blood glucose concentrations.
Due to this mechanism of action, patients receiving canagliflozin will be found to be positive for urine sugar.
, but it is preferable to take it before the first meal of the day and at the same time every day.
The usual dose of canagliflozin used is 100 mg of active ingredient per day. If necessary, your doctor may decide to increase the amount of active substance administered up to 300 mg per day.
Please Note
If your doctor has also prescribed cholestyramine (a bile acid sequestering agent used to reduce excessively high cholesterol levels), canagliflozin should be taken at least one hour before, or 4-6 hours after administration of the aforementioned ingredient. active.
Forgetfulness of a dose
If a dose of canagliflozin is forgotten, it should be taken as soon as the forgotten dose is realized. However, if such forgotten occurs when it is almost time for the next dose, the missed dose should be skipped.The next dose, on the other hand, can be taken at the appointed time.
A double dose should NOT be taken to make up for a forgotten dose. If in doubt, contact your doctor.
.It is not known whether toxicity can also occur in human fetuses and if the excretion of the active substance or its metabolites also occurs in new mothers. For this reason, as a precaution, canagliflozin should NOT be used by pregnant women and mothers. who are breastfeeding.
