Table 3.
Measures against possible side effects of SGLT2 inhibition with canagliflozin in specific patient populations14
| Patient subgroup | Possible AEs with SGLT2 inhibition | Measures |
|---|---|---|
| Women with a history of vaginal fungal infection | Increased risk of recurring genital fungal infections | Sufficient patient information |
| Treatment with oral or topical antimycotics | ||
| Elderly patients (age ≥65 years) | Events in conjunction with volume reduction (eg, orthostatic hypotension, postural dizziness) | Ensure adequate patient hydration (drink sufficiently) |
| Chronic kidney disease (eGFR of 45 to <60 mL/min/1.73 m2) | Events in conjunction with volume reduction (eg, orthostatic hypotension, postural dizziness), raised potassium levels, raised urea | Restrict canagliflozin dose to 100 mg daily (300 mg dose should not be used where eGFR <60 mL/min/1.73 m2) |
| Close monitoring of kidney levels and potassium serum No treatment with canagliflozin when eGFR <45 mL/min/1.73 m2 | ||
| Patients with insulin or sulfonylurea | Hypoglycemia (no intrinsic risk of hypoglycemia under canagliflozin) | Consider a reduction on dose of insulin or sulfonylurea |
| Patients with diuretics | Events in conjunction with volume reduction (eg, orthostatic hypotension, postural dizziness) | Ensure suitable patient hydration (drink sufficiently) |
| Canagliflozin is not recommended in patients receiving loop diuretics |
Notes: Adapted from Mikhail N. Safety of canagliflozin in patients with type 2 diabetes. Curr Drug Saf. 2014;9(2):127–132. Reprinted by permission of Eureka Science Ltd. Copyright © 2014 Bentham Science Publishers.50
Abbreviations: SGLT2, sodium glucose cotransporter 2; AE, adverse event; eGFR, estimated glomerular filtration rate.