Select a medication above to begin.
Invokamet
canagliflozin/ metformin
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle w/ nonspecific sx incl. malaise, myalgias, resp. distress, somnolence, abdominal pain; lab findings incl. lactate >5 mmol/L, anion gap acidosis (w/o evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may incl. renal impairment, concomitant meds, pts 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immed. if lactic acidosis suspected, hospitalize pt and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: TAB: 50 mg/500 mg, 50 mg/1000 mg, 150 mg/500 mg, 150 mg/1000 mg
diabetes mellitus, type 2
- [tx-naive pts]
- Dose: 1 tab PO bid; Start: 50 mg/500 mg PO bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see canagliflozin for cardiovascular event risk reduction use or kidney dz progression and cardiovascular-associated risk reduction use
- [conversion from canagliflozin plus metformin]
- Dose: 1 tab PO bid; Start: equivalent total daily dose of each component in current regimen PO divided bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see canagliflozin for cardiovascular event risk reduction use or kidney dz progression and cardiovascular-associated risk reduction use
- [conversion from canagliflozin]
- Dose: 1 tab PO bid; Start: current daily canagliflozin dose PO divided bid plus metformin 500 mg PO bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see canagliflozin for cardiovascular event risk reduction use or kidney dz progression and cardiovascular-associated risk reduction use
- [conversion from metformin]
- Dose: 1 tab PO bid; Start: canagliflozin 50 mg PO bid plus current daily metformin dose PO divided bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see canagliflozin for cardiovascular event risk reduction use or kidney dz progression and cardiovascular-associated risk reduction use
renal dosing
- [see below]
- eGFR 45-59: max canagliflozin dose 100 mg/day; eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit, max canagliflozin dose 100 mg/day if eGFR 30-44 during tx
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
- Dosage forms: TAB: 50 mg/500 mg, 50 mg/1000 mg, 150 mg/500 mg, 150 mg/1000 mg
diabetes mellitus, type 2
- [tx-naive pts, 10 yo and older]
- Dose: 1 tab PO bid; Start: 50 mg/500 mg PO bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
- [conversion from canagliflozin plus metformin, 10 yo and older]
- Dose: 1 tab PO bid; Start: equivalent total daily dose of each component in current regimen PO divided bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
- [conversion from canagliflozin, 10 yo and older]
- Dose: 1 tab PO bid; Start: current daily canagliflozin dose PO divided bid plus metformin 500 mg PO bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
- [conversion from metformin, 10 yo and older]
- Dose: 1 tab PO bid; Start: canagliflozin 50 mg PO bid plus current daily metformin dose PO divided bid; Max: 300 mg/2000 mg/day; Info: give w/ meals; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
renal dosing
- [see below]
- eGFR 45-59: max canagliflozin dose 100 mg/day; eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit, max canagliflozin dose 100 mg/day if eGFR 30-44 during tx
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: avoid use