SGLT2i + biguanide (fixed-dose)

Canagliflozin with metformin

Brand names: Vokanamet

Adult dose

Dose: 50/850mg or 50/1000mg or 150/850mg or 150/1000mg BD

Route: Oral

Frequency: BD

Clinical pearls

NICE NG28: SGLT2i preferred adjunct to metformin if CV/HF/CKD
MHRA: lower-limb amputation signal stronger with canagliflozin than other SGLT2i — review foot care
Sick-day rules

Contraindications

eGFR <45 (initiation)
Acute illness with dehydration risk
DKA history
Severe hepatic disease
Pregnancy

Side effects

Genitourinary infections
DKA (atypical)
Volume depletion
Lower-limb amputation signal (CANVAS — MHRA)
Fournier's gangrene
Lactic acidosis (rare)

Interactions

Iodinated contrast (withhold metformin)
Diuretics
RAAS inhibitors
Digoxin

Monitoring

HbA1c
eGFR
Foot care
B12 (long-term)
Volume status

Reference: BNF; NICE NG28; MHRA Drug Safety Update; ADA-EASD; https://bnf.nice.org.uk/drugs/canagliflozin-with-metformin/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Dapagliflozin with metformin · SGLT2i + biguanide (fixed-dose)

Pathways