Canagliflozin + Metformin

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Generic Name: Canagliflozin + Metformin Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: N

Uses

What is Canagliflozin + Metformin used for?

Canagliflozin + Metformin is used with a proper diet and exercise program to control high blood sugar in people with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. This medication works by helping to restore your body’s proper response to the insulin you naturally produce. It also increases the removal of sugar by your kidneys, decreases how much sugar is made in your liver, and decreases how much sugar your body takes in through your stomach and intestines.

How should I take Canagliflozin + Metformin?

Your doctor may perform kidney function tests before you start taking canagliflozin and metformin.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, and feeling shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Your doctor may have you take extra vitamin B12 while you are taking canagliflozin and metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking canagliflozin and metformin, which can lead to severely low blood pressure or a serious electrolyte imbalance.

If you need surgery or medical tests, tell any doctor who treats you that you are using canagliflozin and metformin.

Canagliflozin and metformin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor’s instructions very closely.

How do I store Canagliflozin + Metformin?

Store tablets in their original container at room temperature, away from moisture and heat. Do not keep canagliflozin and metformin tablets in a daily pill box for longer than 30 days.

There may be different brands of Canagliflozin + Metformin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Canagliflozin + Metformin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Canagliflozin + Metformin?

Before taking this medication, tell your doctor or pharmacist if you are allergic to canagliflozin or metformin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma, obstructive lung disease), blood problems (such as anemia, vitamin B12 deficiency), dehydration, low blood pressure, heart failure, kidney disease, liver problems, blood mineral imbalances (such as high levels of potassium), yeast infections in the vagina or penis.

Before having surgery or any X-ray/scanning procedure using iodinated contrast, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). You may need to stop this medication for a short time for the surgery/procedure. Ask your doctor or dentist for instructions before your surgery/procedure.

You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.

Limit alcohol while using this medication because it can increase your risk of developing lactic acidosis, low blood sugar, or a high ketone level.

High fever, “water pills” (diuretics such as hydrochlorothiazide), too much sweating, diarrhea, or vomiting may cause loss of too much body water (dehydration) and increase your risk of lactic acidosis. Stop taking this medication and tell your doctor right away if you have prolonged diarrhea or vomiting. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.

It may be harder to control your blood sugar when your body is stressed (such as due to fever, infection, injury, or surgery). Also, if you are eating less or not able to eat due to these conditions or any illness, this can lead to a high ketone level while you are taking this medication. Consult your doctor because this may require a change in your treatment plan, medications, or blood sugar or ketone testing.

Older adults may be at greater risk for side effects such as low blood sugar, dehydration, lactic acidosis, dizziness/fainting (usually when standing), or bone loss while using this drug.

Metformin can cause changes in the menstrual cycle (promote ovulation) and increase the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using this medication.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Pregnancy may cause or worsen diabetes. Discuss a plan with your doctor for managing your blood sugar while pregnant. Your doctor may change your diabetes treatment during your pregnancy (such as diet and medications including insulin).

Metformin passes into breast milk in small amounts. It is unknown if canagliflozin passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Canagliflozin + Metformin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Canagliflozin + Metformin. Canagliflozin + Metformin is pregnancy risk category N according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Canagliflozin + Metformin?

Nausea, vomiting, stomach upset, diarrhea, bloating/gas, frequent urination, unusual dry mouth, or weakness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. If stomach symptoms return later (after taking the same dose for several days or weeks), tell your doctor right away. Stomach symptoms that occur after the first days of your treatment may be signs of lactic acidosis.

An empty tablet shell may appear in your stool. This effect is harmless because your body has already absorbed the medication.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: signs of a urinary tract infection (such as burning/painful/frequent/urgent urination, pink/bloody urine), signs of kidney problems (such as change in the amount of urine, swelling legs/feet), signs of high level of potassium in the blood (such as muscle weakness and slow/irregular heartbeat).

Use of this medication may result in a new yeast infection in the vagina or penis. You are more likely to get a yeast infection if you have had yeast infections in the genital area before. Uncircumcised men are also at an increased risk for infections. Tell your doctor right away if you have signs of yeast infection in the vagina (such as unusual vaginal discharge/burning/itching/odor) or in the penis (such as redness/itching/swelling of the penis, unusual discharge from the penis). Your doctor may direct you to use nonprescription antifungal products to treat these infections. Tell your doctor if your condition lasts or gets worse after treatment.

This medication does not usually cause low blood sugar (hypoglycemia). Low blood sugar may occur if this drug is prescribed with other diabetes medications, or if you do not consume enough calories from food, or if you do unusually heavy exercise. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don’t have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.

Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your doctor may need to adjust your diabetes medications.

This medication may cause you to lose too much body water (dehydration). This can lead to serious kidney damage. Drink plenty of fluids to prevent dehydration. Tell your doctor or pharmacist right away if you are not able to drink fluids as usual, or losing fluid (such as due to vomiting, diarrhea, or heavy sweating). Also, tell your doctor right away if you have any signs of dehydration, such as urinating less than usual, unusual dry mouth/thirst, fast heartbeat, or dizziness/lightheadedness/fainting. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Canagliflozin may cause bone loss (osteoporosis), or even a broken bone. Lifestyle changes that help promote healthy bones include increasing weight-bearing exercise, stopping smoking, limiting alcohol, and eating well-balanced meals that contain adequate calcium and vitamin D. You may also need to take calcium and vitamin D supplements. Consult your doctor for specific advice.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Canagliflozin + Metformin?

Other medications can affect the removal of canagliflozin from your body, which may affect how this medication works. Examples include rifamycins (such as rifampin, rifabutin), certain drugs used to treat seizures (such as phenobarbital, phenytoin), ritonavir, among others.

Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness, hunger, or sweating, are not affected by these drugs.

Many drugs can affect your blood sugar levels, making it more difficult to control your blood sugar. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar regularly as directed by your doctor. Tell your doctor about the results and of any symptoms of high or low blood sugar. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Your urine will test positive for glucose. Make sure lab personnel and all your doctors know you use this drug.

Canagliflozin + Metformin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Canagliflozin + Metformin?

Canagliflozin + Metformin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Canagliflozin + Metformin?

Canagliflozin + Metformin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Canagliflozin + Metformin.

What is the dose of Canagliflozin + Metformin for an adult?

Usual Adult Dose for Diabetes Type 2

Initial dose: Individualize dose based on patient’s current regimen:

Canagliflozin-Metformin Immediate-Release tablets: Take orally twice a day with meals

-In patients not currently on canagliflozin or metformin: canagliflozin 50 mg-metformin 500 mg orally twice a day

-In patients on metformin: canagliflozin 50 mg plus one-half of the total daily metformin dose orally twice a day

-In patients on canagliflozin: one-half daily dose of canagliflozin plus metformin 500 mg orally twice a day

-In patients already on canagliflozin and metformin: Switch to canagliflozin-metformin at the same total daily dose divided into 2 doses taken orally twice a day

Canagliflozin-Metformin Extended-release (XR tablets): Take orally once a day with morning meal

-In patients not currently on canagliflozin or metformin: Initial dose: canagliflozin 100 mg-metformin 1000 mg orally once a day

-In patients on metformin: canagliflozin 100 mg plus total daily metformin dose (or nearest appropriate) orally once a day

-In patients on canagliflozin: current daily dose of canagliflozin plus metformin 1000 mg orally once a day

-In patients already treated with canagliflozin and metformin: Switch to canagliflozin-metformin at the same total daily dose (or nearest appropriate) orally once a day

Maintenance dose: Adjust based on efficacy and tolerability; canagliflozin may be increased from 100 mg/day to 300 mg/day in patients with an eGFR of 60 mL/min/1.73 m2 or greater; a gradual dose escalation of metformin will help to reduce gastrointestinal side effects.

Maximum dose: Canagliflozin 300 mg/day; Metformin 2000 mg/day

Comments:

-When used in combination with insulin or an insulin secretagogue, a lower dose of insulin or insulin secretagogue may be considered to reduce the risk of hypoglycemia.

-For patients taking an evening dose of metformin extended-release (XR) switching to canagliflozin-metformin XR once a day, skip the last evening dose of metformin XR before starting canagliflozin-metformin XR the following morning.

Use: An adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both canagliflozin and metformin is appropriate.

Renal Dose Adjustments

Moderate to severe renal impairment (eGFR below 45 mL/min/1.73m2) and ESRD: Use is contraindicated

Canagliflozin-Metformin Immediate-Release:

-Moderate Renal Dysfunction (eGFR of 45 to less than 60 mL/min/1.73m2): Limit dose of canagliflozin-metformin to canagliflozin 50 mg twice a day

Canagliflozin-Metformin Extended-Release:

-Moderate Renal Dysfunction (eGFR of 45 to less than 60 mL/min/1.73m2): Limit dose of canagliflozin-metformin to canagliflozin 100 mg once a day

IODINATED CONTRAST PROCEDURE:

-Stop this drug at time of, or prior to, an iodinated contrast imaging procedure for patients with an eGFR between 45 and 60 mL/min/1.73m2 ; reevaluate eGFR 48 hours after the imaging procedure and restart drug if renal function is stable (see dose adjustment for full instruction).

Liver Dose Adjustments

Metformin is not recommended in patients with clinical or laboratory evidence of hepatic disease.

IODINATED CONTRAST PROCEDURE:

-Stop this drug at time of, or prior to, an iodinated contrast imaging procedure for patients with a history of liver disease; reevaluate eGFR 48 hours after the imaging procedure and restart drug if renal function is stable (see dose adjustments for full instruction).

Dose Adjustments

Elderly: Monitor renal function more frequently and adjust dose based on renal function.

Concomitant use with UDP-Glucuronosyl Transferase (UGT) Enzyme Inducers:

-Consider increasing the dose of canagliflozin to 150 mg twice a day (or 300 mg once a day) in patients currently tolerating 50 mg twice a day (or 100 mg once a day) who have an eGFR greater than 60 mL/min/1.73m2

-Consider another antihyperglycemic agent in patients with an eGFR of 45 mL/min/1.73m2 to less than 60 mL/min/1.73m2

Concomitant use with drugs that increase the risk of metformin-associated lactic acidosis; impair renal function; result in significant hemodynamic changes, interfere with acid-base balance; or increase metformin accumulation should be undertaken with increased monitoring.

Iodinated Contrast Imaging Procedures:

-Stop this drug at time of, or prior to, an iodinated contrast imaging procedure for patients with an eGFR between 45 and 60 mL/min/1.73m2

-Stop this drug at time of, or prior to, an iodinated contrast imaging procedure; for patients with a history of liver disease, alcoholism, or heart failure.

-Stop this drug at time of, or prior to, an iodinated contrast imaging procedure for patients who will be administered intra-arterial iodinated contrast.

Reevaluate eGFR 48 hours after the imaging procedure and only restart this drug if renal function is stable.

Dialysis

Contraindicated

What is the dose of Canagliflozin + Metformin for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Canagliflozin + Metformin available?

Canagliflozin + Metformin is available in the following dosage forms and strengths:

  • Oral tablet,
  • Oral tablet, extended release.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Canagliflozin + Metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 29, 2018 | Last Modified: August 29, 2018

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