SGLT2 Inhibitor Pregnancy: Canagliflozin should not be used during pregnancy; when pregnancy is detected, treatment should be discontinued. Should not be used during breast-feeding.

Canagliflozin

Brand names: Invokana

Canagliflozin is an SGLT2 inhibitor for type 2 diabetes, with additional cardiovascular and renal benefit in appropriate patients.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 100 mg once daily (recommended starting dose); can be increased to 300 mg once daily

Route: Oral

Frequency: Once daily, preferably before the first meal of the day

Max: 300 mg once daily

In patients tolerating 100 mg once daily who have eGFR >= 60 mL/min/1.73 m2 or CrCl >= 60 mL/min and need tighter glycaemic control, the dose can be increased to 300 mg once daily. Tablets should be swallowed whole. Care should be taken when increasing the dose in patients >= 75 years of age, those with known cardiovascular disease, or others for whom canagliflozin-induced diuresis poses a risk. Correct volume depletion prior to initiation. When used with insulin or an insulin secretagogue, a lower dose of those agents may be considered to reduce hypoglycaemia risk. Should not be used in type 1 diabetes mellitus.

Dose adjustments

Renal

eGFR >= 60: initiate 100 mg, may increase to 300 mg. eGFR 30 to 60: use 100 mg once daily. eGFR < 30: continue 100 mg for patients already taking Invokana (until dialysis or renal transplantation); Invokana should not be initiated. For diabetic kidney disease as add-on to standard of care, use 100 mg once daily. Not recommended in severe hepatic impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Assess renal function before initiating and as clinically indicated ( 2.1 ) The recommended starting dose is 100 mg once daily, taken before the first meal of the day ( 2.2 ) Dose can be increased to 300 mg once daily in patients tolerating 100 mg once daily who have an eGFR of 60 mL/min/1.73 m 2 or greater and require additional glycemic control ( 2.2 ) Dose adjustment for patients with renal impairment may be required ( 2.3 ) See full prescribing information for INVOKANA dosage modifications due to drug interactions ( 2.4 ) Withhold INVOKANA at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting ( 2.5 ). 2.1 Prior to Initiation of INVOKANA …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-10-24. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Vulvovaginal candidiasis (very common)
Balanitis or balanoposthitis (common)
Urinary tract infection (common)
Hypoglycaemia (in combination with insulin or a sulphonylurea)
Polyuria or pollakiuria (urinary frequency)

Interactions

Insulin or insulin secretagogues (e.g. sulphonylurea) — increased risk of hypoglycaemia; a lower dose of insulin/secretagogue may be needed
UGT enzyme inducers (e.g. rifampicin, phenytoin, phenobarbital, ritonavir) — decrease canagliflozin exposure; dose increase to 200 mg once daily may be considered (max 300 mg) based on renal function
Digoxin — canagliflozin increases digoxin exposure

Clinical monograph

How it works

It inhibits the sodium-glucose co-transporter 2 in the proximal renal tubule, increasing urinary glucose excretion and lowering blood glucose independently of insulin; the accompanying natriuresis contributes to its cardiorenal effects.

Prescribing in practice

Euglycaemic diabetic ketoacidosis can occur — ketoacidosis is possible even with near-normal glucose; advise 'sick-day' rules and withhold during acute illness, dehydration or before major surgery.
Genital fungal infections and volume depletion are common; rare necrotising fasciitis of the perineum (Fournier's gangrene) is reported.
Canagliflozin in particular was associated with increased lower-limb amputation and fracture risk in trials — assess foot risk.

Monitoring

Monitor renal function and volume status; check ketones if the patient is unwell, regardless of glucose level.

Counselling the patient

Pause it and seek advice during acute illness, vomiting or dehydration (sick-day rules).
Report genital itching/discharge, or any severe pain, swelling or redness around the genitals/perineum, urgently.
Ketoacidosis symptoms (nausea, vomiting, abdominal pain, breathlessness) need urgent review even if your glucose seems normal.

Evidence & guidelines

SGLT2 inhibitors reduce cardiovascular and renal events in type 2 diabetes (NICE NG28; CANVAS/CREDENCE for canagliflozin).

Reference: NICE NG28 (Type 2 DM); CREDENCE Trial (NEJM 2019); CANVAS Trial (NEJM 2017); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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