Peringatan Keamanan

Overdose information

If an overdose occurs, contact the Poison Control Center. Normal supportive measures should be taken, including the removal unabsorbed drug from the gastrointestinal tract, initiating clinical monitoring of the patient, and providing supportive treatment as deemed necessary. Canagliflozin has been removed in very small quantities after a 4-hour hemodialysis session. This drug is likely not dialyzable by peritoneal dialysis FDA label.

Pregnancy and lactation

Animal data has demonstrated that canagliflozin may cause adverse renal effects in a growing fetus. Data are insufficient at this time in determining a potential canagliflozin related risk for major birth defects or possible miscarriage in humans FDA Label. There are known risks, however, of uncontrolled diabetes in pregnancy FDA label. Inform female patients taking canagliflozin of the potential risk, which is increased during the second and third trimesters. This drug is not recommended during nursing FDA label.

Mutagenesis and carcinogenicity

Canagliflozin was not found to be mutagenic in both metabolically activated and inactivated states in the Ames assay. Canagliflozin showed mutagenicity in laboratory mouse lymphoma assay, but only in the activated state. Canagliflozin was not found to be mutagenic in several in vivo assays performed on rats FDA label.

The carcinogenic risk of canagliflozin was assessed in 2-year studies completed in both CD1 mice and Sprague-Dawley rats. Canagliflozin was not shown to increase tumor incidence in mouse models given doses less than or equal to 14 times the exposure from a typical 300 mg dose in humans. Despite these negative findings in mice, the incidence of several tumors increased in mice, including Leydig cell tumors, renal tubular adenomas, and adrenal pheochromocytomas FDA label.

Canagliflozin

DB08907

small molecule approved

Deskripsi

Canagliflozin, also known as Invokana, is a sodium-glucose cotransporter 2 (SGLT2) inhibitor used in the management of type 2 diabetes mellitus along with lifestyle changes including diet and exercise FDA label.

It was initially approved by the FDA in 2013 for the management of diabetes and later approved in 2018 for a second indication of reducing the risk of cardiovascular events in patients diagnosed with type 2 diabetes mellitus L5897, FDA label.

Canagliflozin is the first oral antidiabetic drug approved for the prevention of cardiovascular events in patients with type 2 diabetes L5897. Cardiovascular disease is the most common cause of death in these patients A177083.

Struktur Molekul 2D

Berat 444.516
Wujud solid

Peta Jejaring Molekuler
Legenda: ObatTargetGenEnzim(Panah → menunjukkan arah efek / relasi)TransporterCarrier

Profil Farmakokinetik

Waktu Paruh (Half-Life) In a clinical study, the terminal half-life of canagliflozin was 10.6 hours for the 100mg dose and 13.1 hours for the 300 mg dose [FDA label].
Volume Distribusi This drug is extensively distributed throughout the body. On average, the volume of distribution of canagliflozin at steady state following a single intravenous dose in healthy patients was measured to be 83.5 L [FDA label].
Klirens (Clearance) In healthy subjects, canagliflozin clearance was approximately 192 mL/min after intravenous (IV) administration [FDA Label]. The renal clearance of 100 mg and 300 mg doses of canagliflozin was measured to be in the range of 1.30 - 1.55 mL/min [FDA label].

Absorpsi

Bioavailability and steady-state The absolute oral bioavailability of canagliflozin, on average, is approximately 65% FDA label. Steady-state concentrations are achieved after 4 to 5 days of daily dose administration between the range of 100mg to 300mg FDA label. Effect of food on absorption Co-administration of a high-fat meal with canagliflozin exerted no appreciable effect on the pharmacokinetic parameters of canagliflozin. This drug may be administered without regard to food. Despite this, because of the potential of canagliflozin to decrease postprandial plasma glucose excretion due to prolonged intestinal glucose absorption, it is advisable to take this drug before the first meal of the day FDA label.

Metabolisme

Canagliflozin is primarily metabolized by O-glucuronidation. It is mainly glucuronidated by UGT1A9 and UGT2B4 enzymes to two inactive O-glucuronide metabolites FDA Label. The oxidative metabolism of canagliflozin by hepatic cytochrome enzyme CYP3A4 is negligible (about 7%) in humans FDA label.

Rute Eliminasi

After a single oral radiolabeled dose canagliflozin dose to healthy subjects, the following ratios of canagliflozin or metabolites were measured in the feces and urine FDA label: Feces 41.5% as the unchanged radiolabeled drug 7.0% as a hydroxylated metabolite 3.2% as an O-glucuronide metabolite Urine About 33% of the ingested radiolabled dose was measured in the urine, generally in the form of O-glucuronide metabolites. Less than 1% of the dose was found excreted as unchanged drug in urine.

Interaksi Makanan

3 Data
  • 1. Avoid alcohol. Excess alcohol intake may promote ketoacidosis.
  • 2. Drink plenty of fluids.
  • 3. Take before a meal. It is recommended to take this drug before the first meal of the day.

Interaksi Obat

1571 Data
Pegvisomant The risk or severity of hypoglycemia can be increased when Pegvisomant is combined with Canagliflozin.
Duloxetine The risk or severity of orthostatic hypotension and syncope can be increased when Canagliflozin is combined with Duloxetine.
Levodopa The risk or severity of hypotension and orthostatic hypotension can be increased when Canagliflozin is combined with Levodopa.
Risperidone Canagliflozin may increase the hypotensive activities of Risperidone.
Afatinib The serum concentration of Afatinib can be increased when it is combined with Canagliflozin.
Bosutinib The serum concentration of Bosutinib can be increased when it is combined with Canagliflozin.
Brentuximab vedotin The serum concentration of Brentuximab vedotin can be increased when it is combined with Canagliflozin.
Colchicine The serum concentration of Colchicine can be increased when it is combined with Canagliflozin.
Edoxaban The serum concentration of Edoxaban can be increased when it is combined with Canagliflozin.
Ledipasvir The serum concentration of Ledipasvir can be increased when it is combined with Canagliflozin.
Naloxegol The serum concentration of Naloxegol can be increased when it is combined with Canagliflozin.
Pazopanib The serum concentration of Pazopanib can be increased when it is combined with Canagliflozin.
Prucalopride The serum concentration of Prucalopride can be increased when it is combined with Canagliflozin.
Ranolazine The serum concentration of Ranolazine can be increased when it is combined with Canagliflozin.
Silodosin The excretion of Silodosin can be decreased when combined with Canagliflozin.
Topotecan The serum concentration of Topotecan can be increased when it is combined with Canagliflozin.
Valsartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Valsartan.
Olmesartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Olmesartan.
Losartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Losartan.
Candesartan cilexetil The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Candesartan cilexetil.
Eprosartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Eprosartan.
Telmisartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Telmisartan.
Irbesartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Irbesartan.
Forasartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Forasartan.
Saprisartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Saprisartan.
Tasosartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Tasosartan.
Saralasin The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Saralasin.
Azilsartan medoxomil The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Azilsartan medoxomil.
Fimasartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Fimasartan.
Candesartan The risk or severity of hypotension, hyperkalemia, and reduced intravascular volume can be increased when Canagliflozin is combined with Candesartan.
Trandolaprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Trandolaprilat.
Moexiprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Moexiprilat.
Ramipril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Ramipril.
Fosinopril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Fosinopril.
Trandolapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Trandolapril.
Enalapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Enalapril.
Moexipril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Moexipril.
Lisinopril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Lisinopril.
Perindopril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Perindopril.
Quinapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Quinapril.
Omapatrilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Omapatrilat.
Rescinnamine The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Rescinnamine.
Cilazapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Cilazapril.
Spirapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Spirapril.
Temocapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Temocapril.
Enalaprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Enalaprilat.
Imidapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Imidapril.
Zofenopril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Zofenopril.
Delapril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Delapril.
Benazeprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Benazeprilat.
Fosinoprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Fosinoprilat.
Ramiprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Ramiprilat.
Perindoprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Perindoprilat.
Quinaprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Quinaprilat.
Captopril The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Captopril.
Cilazaprilat The risk or severity of renal failure, hypotension, and hyperkalemia can be increased when Canagliflozin is combined with Cilazaprilat.
Everolimus The serum concentration of Everolimus can be increased when it is combined with Canagliflozin.
Rifaximin The serum concentration of Rifaximin can be increased when it is combined with Canagliflozin.
Torasemide The risk or severity of hypotension can be increased when Canagliflozin is combined with Torasemide.
Furosemide The risk or severity of hypotension can be increased when Canagliflozin is combined with Furosemide.
Bumetanide The risk or severity of hypotension can be increased when Canagliflozin is combined with Bumetanide.
Etacrynic acid The risk or severity of hypotension can be increased when Canagliflozin is combined with Etacrynic acid.
Piretanide The risk or severity of hypotension can be increased when Canagliflozin is combined with Piretanide.
Azosemide The risk or severity of hypotension can be increased when Canagliflozin is combined with Azosemide.
Tripamide The risk or severity of hypotension can be increased when Canagliflozin is combined with Tripamide.
Phenytoin The serum concentration of Canagliflozin can be decreased when it is combined with Phenytoin.
Fosphenytoin The serum concentration of Canagliflozin can be decreased when it is combined with Fosphenytoin.
Rifampin The serum concentration of Canagliflozin can be decreased when it is combined with Rifampicin.
Carbamazepine The metabolism of Canagliflozin can be increased when combined with Carbamazepine.
Efavirenz The serum concentration of Canagliflozin can be decreased when it is combined with Efavirenz.
Primidone The serum concentration of Canagliflozin can be decreased when it is combined with Primidone.
Methylphenobarbital The serum concentration of Canagliflozin can be decreased when it is combined with Methylphenobarbital.
Phenobarbital The serum concentration of Canagliflozin can be decreased when it is combined with Phenobarbital.
Lipoic acid The risk or severity of hypoglycemia can be increased when Lipoic acid is combined with Canagliflozin.
Aripiprazole lauroxil Aripiprazole lauroxil may increase the hypotensive activities of Canagliflozin.
Nicorandil Nicorandil may increase the hypotensive activities of Canagliflozin.
Moxifloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Moxifloxacin.
Grepafloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Grepafloxacin.
Enoxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Enoxacin.
Pefloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Pefloxacin.
Ciprofloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Ciprofloxacin.
Trovafloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Trovafloxacin.
Nalidixic acid The therapeutic efficacy of Canagliflozin can be increased when used in combination with Nalidixic acid.
Rosoxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Rosoxacin.
Cinoxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Cinoxacin.
Lomefloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Lomefloxacin.
Gatifloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Gatifloxacin.
Norfloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Norfloxacin.
Levofloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Levofloxacin.
Gemifloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Gemifloxacin.
Ofloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Ofloxacin.
Sparfloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Sparfloxacin.
Temafloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Temafloxacin.
Fleroxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Fleroxacin.
Technetium Tc-99m ciprofloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Technetium Tc-99m ciprofloxacin.
Garenoxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Garenoxacin.
Nemonoxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Nemonoxacin.
Flumequine The therapeutic efficacy of Canagliflozin can be increased when used in combination with Flumequine.
Enrofloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Enrofloxacin.
Orbifloxacin The therapeutic efficacy of Canagliflozin can be increased when used in combination with Orbifloxacin.

Target Protein

Sodium/glucose cotransporter 2 SLC5A2

Referensi & Sumber

Artikel (PubMed)
  • PMID: 23590413
    Lamos EM, Younk LM, Davis SN: Canagliflozin , an inhibitor of sodium-glucose cotransporter 2, for the treatment of type 2 diabetes mellitus. Expert Opin Drug Metab Toxicol. 2013 Jun;9(6):763-75. doi: 10.1517/17425255.2013.791282. Epub 2013 Apr 17.
  • PMID: 27181936
    Osaki A, Okada S, Saito T, Yamada E, Ono K, Niijima Y, Hoshi H, Yamada M: Renal threshold for glucose reabsorption predicts diabetes improvement by sodium-glucose cotransporter 2 inhibitor therapy. J Diabetes Investig. 2016 Sep;7(5):751-4. doi: 10.1111/jdi.12473. Epub 2016 Feb 16.
  • PMID: 28836175
    Deeks ED, Scheen AJ: Canagliflozin: A Review in Type 2 Diabetes. Drugs. 2017 Sep;77(14):1577-1592. doi: 10.1007/s40265-017-0801-6.
  • PMID: 24569552
    Joseph JJ, Golden SH: Type 2 diabetes and cardiovascular disease: what next? Curr Opin Endocrinol Diabetes Obes. 2014 Apr;21(2):109-20. doi: 10.1097/MED.0000000000000044.
  • PMID: 18695749
    Gleissner CA, Galkina E, Nadler JL, Ley K: Mechanisms by which diabetes increases cardiovascular disease. Drug Discov Today Dis Mech. 2007;4(3):131-140. doi: 10.1016/j.ddmec.2007.12.005.
  • PMID: 23882055
    Mannucci E, Dicembrini I, Lauria A, Pozzilli P: Is glucose control important for prevention of cardiovascular disease in diabetes? Diabetes Care. 2013 Aug;36 Suppl 2:S259-63. doi: 10.2337/dcS13-2018.
Textbook
  • Steven L. Cowart and Max E. Stachura (1990). Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. (3rd ed.). Butterworths.

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