Invokana (Canagliflozin)
Also sold as: Invokana, Cana, Canaglu, Invokamet (with metformin), Canasig
Pregnancy
Cat C
Lactation
Avoid
Schedule
H
Forms
Tablet 100mg, 300mg
Indications
- Type 2 diabetes mellitus
- Cardiovascular risk reduction in T2DM with established CVD (CANVAS trial)
- Chronic kidney disease (CKD) with or without T2DM — slows CKD progression (CREDENCE trial)
- Heart failure with reduced ejection fraction (HFrEF) — with or without T2DM
Adult Dosing
T2DM
100 mg PO once daily before first meal; increase to 300 mg if tolerated and more glycaemic control needed
Ongoing
CKD / CV risk reduction
100 mg PO once daily
Use 100 mg regardless of glycaemic control if CKD/CVD indication
Pediatric Dosing
No paediatric indication
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| eGFR ≥ 60 | 100-300 mg OD (full glycaemic benefit) |
| eGFR 30-60 | 100 mg OD (glycaemic benefit limited but cardiorenal protection continues) |
| eGFR < 30 | Use ONLY for cardiorenal indication at 100 mg OD; avoid for glycaemia alone |
| Dialysis | AVOID for glycaemia. Cardiorenal — limited data. |
Hepatic Adjustment
No significant hepatic adjustment needed (mild); avoid in severe impairment
Pregnancy & Lactation
Pregnancy: Category C
Avoid — animal studies show renal toxicity. Use insulin or metformin in pregnancy.
Lactation: Avoid
Unknown breast milk excretion. Avoid.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Loop diuretics (furosemide) | Additive diuresis and hypotension/dehydration risk — monitor volume status | Moderate |
| Insulin / Sulfonylureas | Increased hypoglycaemia risk — reduce insulin/sulfonylurea dose by 20-30% | Moderate |
| UGT inducers (rifampicin, phenytoin, ritonavir) | Reduce canagliflozin levels — increase to 300 mg if tolerated | Moderate |
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Side Effects
Common
- Genital mycotic infections (thrush) — very common in women
- UTI
- Osmotic diuresis (polyuria, polydipsia)
- Hypotension / dizziness
- Increased urination
Serious / Discontinue If
- Diabetic ketoacidosis (DKA) — even with near-normal glucose (euglycaemic DKA; stop 3-4 days before surgery)
- Lower limb amputations — toe, foot (canagliflozin specific risk — CANVAS trial; not seen with other SGLT-2)
- Fournier's gangrene (rare perineal necrotising fasciitis)
- Acute kidney injury (volume depletion)
- Urosepsis
- Bone fractures (canagliflozin — modest increased risk)
Contraindications
- Type 1 diabetes
- DKA
- eGFR < 30 (for glycaemic indication)
- Recurrent UTI or genital infections
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Invokana 100mg | J&J (Janssen) | 14 tab ₹985 |
| Cana 100mg | Sun Pharma | 14 tab ₹545 |
| Canaglu 100mg | Lupin | 14 tab ₹525 |
Monitoring Required
- HbA1c (3-6 monthly)
- eGFR and creatinine (baseline and regularly — monitoring CKD progression benefit)
- Blood pressure (orthostatic)
- Genital/urinary infections
- Foot and lower limb examination (amputation risk)
- Ketones if unwell (euglycaemic DKA risk)
Patient Counseling Points
- Take before the first meal of the day
- Genital infections (thrush) common — good hygiene; report if recurrent
- Drink plenty of fluids — osmotic diuresis causes dehydration
- ⚠️ STOP canagliflozin at least 3-4 days before surgery, fasting, or serious illness (DKA risk)
- Report: foot pain, skin changes, wounds on feet (lower limb amputation risk)
- Report severe abdominal pain, vomiting, rapid breathing (DKA signs)
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Clinically reviewed by: Dr. Meena Reddy, DM (Endocrinology), Senior Diabetologist
Last reviewed: 2026-04-01
References
- BNF — Canagliflozin
- CANVAS Trial
- CREDENCE Trial
- ADA Standards of Care 2025
- FDA Canagliflozin Safety Communication