What is Canagliflozin
Canagliflozin was approved by FDA in the year 2013 for the treatment of diabetes type two. Canagliflozin is best recommended when used together with exercise and diet control as management of type two diabetes mellitus. It helps improve glucose control in the body through the kidney. However, for patients with type one diabetes, Canagliflozin does not work. It's also not effective in patients presenting with Diabetic KetoAcidosis. Canagliflozin is most recommended when the common drug Metformin is rendered ineffective due to lactose intolerance among other contraindications. This is the second most considered drug of choice. Canagliflozin is a new drug in the treatment of diabetes type two. This class of Sodium Glucose Transport Protein 2 inhibitors is more potent as compared to their predecessor SGLT1 inhibitors.
Canagliflozin is in a class called the Sodium-Glucose Transport Protein Blockers. Other SGLT2 inhibitors include dapagliflozin and empagliflozin It can also be in the following categories- Anti-diabetic drug Other Names of Canagliflozin 1. Invokana 2. Canagliflozin Hemihydrate 3. Anhydrous Canagliflozin 4. Canagliflozin Anhydrous 5. Hemihydrate Canagliflozin 6. 1-(Glucopyranosyl)-4-methyl-3-(5-(4-fluorophenyl)-2-thienylmethyl)benzene - T777973Mode of ActionThe mode of action of Canagliflozin is by blocking the SGLT2 (Sodium-Glucose Transport Protein). The Sodium Glucose Transport Protein is located in the Kidney and its main function is to reabsorb filtered glucose. By blocking the action of the sodium-glucose transport protein, Canagliflozin manages to reduce excess sugars in the body thus preventing hyperglycemia. It increases the glucose output through the urine. That is why clients who take this drug experience Glycosuria (excretion of glucose in urine)
How To Use And Dosage
As a tablet, Canagliflozin is available as 0.1g and 0.3g. In diabetes type two, Canagliflozin works best when you combine it with proper diet and exercise. As you begin your initial treatment, a dose of 0.1g is given orally once a day before you consume your first meal of the day. If a patient tolerates 100mg of Canagliflozin the dose might be increased to 300mg per day or more if the patient has renal impairment or a GFR of 60mls/min. Canagliflozin dosage is adjusted to patients with renal impairment, hepatic impairment and those who are taking canagliflozin concomitantly with other CYP2 drug inducers such as rifampin and alcohol.
Side Effects and Precautions
- Dehydration - If you don't control how you take your fluids, Canagliflozin will make you dehydrated since it leads to a lot of water loss through the kidneys. This might make you feel light, drowsy or make you faint especially when you rise up from a seating or sleeping position suddenly. People who are at a higher risk to dehydration include those with hypotension or those who take hypertensive medication. This is also a trend in people who have kidney conditions i.e. dialysis patients and the elderly (age 70 and above). It is recommended that you seek professional help when you get yourself losing to much water.
- Increased Ketones In Blood (KetoAcidosis)- The mechanism of the drug of removing excess glucose in a bid to achieve glycemic control in patients with type two diabetes triggers ketone release. Since there is a reduction in the glucose in the body which is required for energy production, the body turns to ketone stores to generate energy for the body and thus prolonged use of Canagliflozin with no proper diet leads to ketoacidosis which is worse especially in diabetic patients. Ketoacidosis is serious and requires admission in hospital. Ketoacidosis Kills and thus the patient needs to assess the blood sugars every now and then.
- Kidney Injury - Some patients on this medication have sustained acute kidney injuries. Note for signs of loss of appetite for both meals and drinks, nausea, vomiting and diarrhea and call your doctor As soon as possible.
- Urinary Tract Infections - Canagliflozin has been associated with causing urinary tract infection due to its glycosuric effect. Passing too much glucose through the urethra predisposes the area around the vagina and the penis to infections. If you notice any signs and symptoms of an impending urinary tract infection such as burning sensation when urinating, the urgency to urinate always, increased body temperature and blood in urine, contact your doctor as soon as possible
- Hypoglycemia Risk - Canagliflozin works to reduce the blood sugar in the body however, it might lead to severe hypoglycemia especially if the person taking the medication does not eat food as expected. Too much removal of glucose from the body leads to hypoglycemia in this case, you will experience dizziness, headache, fatigue and to the severe side confusion, shaking and increased heartbeat. If you note any of this signs, seek professional help from a medical personnel.
- Yeast Infections- Both men and women are at risk of getting a yeast infection while using Canagliflozin. Women are at a risk of getting a vaginal yeast infection. The signs and symptoms should be noted and seek a medical professional. They include abnormal vaginal discharge i.e. white or yellowish discharge, Foul smelling discharge or excessive itching of the vagina. The men, on the other hand, might get balanitis which is a yeast infection of the penis. It affects the area around the penis. Symptoms include a change of penis color, swelling of the penis, Smelly discharge, pain and rash or itching around the penis. You should see your doctor immediately when you get such an infection.
- Allergic Reaction- Normally, Canagliflozin has no reports of a serious adverse reaction but when it does happen, report immediately.
- Bone Fractures- The mechanism of canagliflozin in bone fractures is not well defined but there have some though rare reports that it causes brittle bones which break easily. If you notice such an issue, report to your doctor.
- Lowers Vitamin B12- Using canagliflozin for too long lowers the levels of vitamin b12 in your blood. Vitamin B12 is essential especially for pregnant women since it prevents neural tube defects in the unborn babies.
Canagliflozin as any other drugs interacts with certain drugs to bring out a negative effect. The following drugs should not be taken together with Canagliflozin. They include: Aliskiren, Digoxin, Carbamazepine, Fosinopril, Enalapril, Rifampin Heparin, Pentamidine, Insulin.
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