Canagliflozin with metformin

eMC §4.2 (Vokanamet 50 mg/1000 mg film-coated tablets); applies to adults with normal renal function (eGFR >= 90 mL/min/1.73 m2). The dose should be individualised on the basis of the patient's current regimen, effectiveness and tolerability, using a recommended canagliflozin daily dose of 100 mg or 300 mg and not exceeding the maximum recommended daily dose of metformin. For patients tolerating a dose containing canagliflozin 50 mg who need tighter glycaemic control, the dose can be increased to the presentation containing canagliflozin 150 mg twice daily. Take care when increasing from canagliflozin 50 mg to 150 mg in patients aged 75 years or over, patients with known cardiovascular disease, or others for whom the initial canagliflozin-induced diuresis poses a risk. Correct volume depletion before initiation. SWITCHING from separate tablets: initiate at the same total daily dose of canagliflozin and metformin already being taken (or the nearest therapeutically appropriate metformin dose); canagliflozin titration added to the optimal metformin dose should be considered before switching. When used as add-on to insulin or an insulin secretagogue (e.g. a sulphonylurea), a lower dose of the insulin or secretagogue may be considered to reduce the risk of hypoglycaemia. Missed dose: take as soon as remembered unless it is time for the next dose, in which case skip it and take the next scheduled dose. Elderly: use with caution as age increases, with regular assessment of renal function. Hepatic impairment: contraindicated. If no adequate combination strength is available, the individual mono-components should be used instead of the fixed-dose combination. PAEDIATRIC: safety and efficacy in children under 18 years have not been established and no data are available; verify against a children's formulary.