Table 2.
Comparison of dapagliflozin and canagliflozin
| Dapagliflozin14 | Canagliflozin51 | |
|---|---|---|
| Approved indication | Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes | Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes |
| Starting dose | 5 mg once-daily in the morning | 100 mg once-daily |
| Dose titration | May increase to 10 mg for additional glycemic control | May increase to 300 mg with an eGFR ≥60 mL/min/1.73 m2, for additional glycemic control |
| A1c reduction | Monotherapy: −0.8% (5 mg) and −0.9% (10 mg) With metformin: −0.7% (5 mg) and −0.8% (10 mg) With glimepiride: −0.6% (5 mg) and −0.8% (10 mg) With pioglitzone: −0.8% (5 mg) and −1.0% (10 mg) With sitagliptin: NS (5 mg) and −0.45% (10 mg) |
Monotherapy: −0.77% (100 mg) and −1.03% (300 mg) With metformin: −0.79% (100 mg) and −0.94% (300 mg) With sulfonylurea: −0.70% (100 mg) and −0.79% (300 mg) |
| Administration | With or without food | Before the first meal of the day |
| Contraindications | Hypersensitivity, severe renal impairment, end stage renal disease, on dialysis | Hypersensitivity, severe renal impairment, end stage renal disease, on dialysis |
| Warning and precautions | Hypotension, increased serum creatinine, decrease in eGFR, hypoglycemia with insulin and insulin secretagogues, genital mycotic infections, increase in LDL, bladder cancer | Hypotension, increased serum creatinine, decrease in eGFR, hyperkalemia, hypoglycemia with insulin and insulin secretagogues, genital mycotic infections, increase in LDL |
| Common side effects (5% or greater incidence) | Female genital mycotic infections, nasopharyngitis, urinary tract infections | Female genital mycotic infections, urinary tract infections, increased urination |
| Drug interactions (avoid use) | None reported | Pimozide |
| Drug interactions (monitor concomitant use) | May increase effect of hypoglycemia agents and hypotensive agents | Digoxin (increased AUC and Cmax) UGT enzyme inducers* (decrease AUC of canagliflozin) |
| Renal impairment | Do not initiate if eGFR <60 mL/min/1.73 m2 Discontinue if eGFR is persistently <60 mL/min/1.73 m2 |
Do not initiate if eGFR <45 mL/min/1.73 m2 Discontinue if eGFR falls below 45 mL/min/1.73 m2 100 mg daily is maximum dose with eGFR 45–60 mL/min/1.73 m2 |
| Hepatic impairment | Assess risk: benefit with severe hepatic impairment | Not recommended with severe hepatic impairment |
| Special populations | Pregnancy category: C Breastfeeding: unknown excretion in breast milk Pediatrics: not studied Geriatrics: higher incidence of ADRs; similar A1c reduction compared to those <65 years old |
Pregnancy category: C Breastfeeding: unknown excretion in breast milk Pediatrics: not studied Geriatrics: higher incidence of ADRs; less A1c reduction compared to those <65 years old |
| How supplied | 5 mg and 10 mg tablets | 100 mg and 300 mg tablets |
Note:
*
Rifampin, phenytoin, phenobarbital, ritonavir.
Abbreviations: eGFR, estimated glomerular filtration rate; NS, not studied; LDL, low-density lipoprotein; AUC, area under the curve; Cmax, peak drug concentration; UGT, UDP-glucuronosyltransferase; ADRs, adverse drug reactions.