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Canagliflozin is an oral C-glycosyl compound antihyperglycemic agent. Sodium-glucose co-transporter 2 (SGLT2) is expressed on the proximal renal tubules and is primarily responsible for the reabsorption of 90% of the glucose filtered by our kidneys. Canagliflozin inhibits the proximal renal tubules' SGLT2 receptors. This action decreases renal glucose absorption and the renal threshold for glucose and increases urinary excretion. Canagliflozin was approved in 2013 by the Food and Drug Administration (FDA). Canagliflozin is utilized to treat patients who are diagnosed with type 2 diabetes mellitus (T2DM) and other disease states with either approved or non-FDA-approved indications. This activity focuses on the indications, contraindications, mechanism of action, adverse effects, and other critical features of canagliflozin. Incorporating considerations for special populations, such as pregnancy, lactation, and renal or hepatic impairment, strengthens the implementation of safe prescribing practices. This comprehensive educational activity aims to promote proficiency in utilizing this knowledge to maximize medication efficacy and minimize the risk of adverse drug events. Objectives: Identify FDA-approved and non-approved indications of canagliflozin. Select patients who may benefit from therapy with canagliflozin by incorporating previous medical history, risk factors, and diabetes status. Implement the appropriate dosing strategies for patients who may benefit from therapy with canagliflozin. Collaborate within an interprofessional team to enhance communication and coordination of care, aiming to advance understanding of canagliflozin and optimize patient outcomes. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose Canagliflozin overdose and toxicity can increase the risk of hypoglycemia when administered with other diabetic medications. If a patient has severe hypoglycemia, they should self-administer an emergency glucagon kit. Additional symptoms of overdose include severe dehydration, electrolyte imbalances, and constant low blood pressure. Management of Overdose If an overdose is suspected, it is crucial to seek immediate medical attention and contact emergency services such as the poison control center. Overdose treatment typically consists of supportive care to reverse electrolyte imbalances with fluid replacement and additional supportive measures to manage symptoms.[12] If clinicians deem it necessary to remove unabsorbed drug components of canagliflozin, a 4-hour hemodialysis session can remove canagliflozin to negligible levels. Healthcare teams should implement clinical monitoring based on the patient's health status. As canagliflozin is highly protein plasma bound, it is not expected to be dialyzable through peritoneal dialysis.

Canagliflozin is an excellent third-line choice of therapy among the multiple options of antihyperglycemic agents for treating T2DM. Combined with diet and exercise, canagliflozin demonstrates substantial efficacy in controlling blood glucose levels in T2DM. In addition to benefits for patients with diabetes, canagliflozin is an effective agent in reducing cardiovascular risks such as stroke and has shown notable benefits in lowering the risk of renal complications. Unlike other SGLT2 inhibitors, such as dapagliflozin and empagliflozin, canagliflozin exhibits a comparatively longer half-life, between 10 to 13 hours, permitting daily dosing. Healthcare professionals must have comprehensive knowledge of canagliflozin's indications, contraindications, and potential adverse effects. However, the medication can cause euglycemic diabetic ketoacidosis, especially in patients with a history of pancreatitis. Therefore, clinicians must monitor for signs or symptoms of dehydration and abnormal kidney function throughout the treatment. Canagliflozin use requires collaboration among an interprofessional healthcare team to effectively optimize therapy outcomes. Typically, physicians or advanced care practitioners will initiate treatment. Pharmacists should diligently monitor for potential drug interactions, such as loop diuretics or rifampin. In addition, pharmacists should also verify dosing and educate patients on common adverse drug reactions. Nurses should assess patient adherence to the medication regimen and offer counseling on medication administration. Both pharmacy and nursing staff should alert a patient's prescriber if they encounter any issues. In cases of overdose, the entire team, especially emergency medicine clinicians, should focus on stabilizing the patient's condition and addressing electrolyte imbalances or signs of dehydration. In a severe case of overdose, collaboration with medical toxicologists, specialized care, and close monitoring in a critical care unit are vital.

Canagliflozin use requires collaboration among an interprofessional healthcare team to effectively optimize therapy outcomes. Typically, physicians or advanced care practitioners will initiate treatment. Pharmacists should diligently monitor for potential drug interactions, such as loop diuretics or rifampin. In addition, pharmacists should also verify dosing and educate patients on common adverse drug reactions. Nurses should assess patient adherence to the medication regimen and offer counseling on medication administration. Both pharmacy and nursing staff should alert a patient's prescriber if they encounter any issues. In cases of overdose, the entire team, especially emergency medicine clinicians, should focus on stabilizing the patient's condition and addressing electrolyte imbalances or signs of dehydration. In a severe case of overdose, collaboration with medical toxicologists, specialized care, and close monitoring in a critical care unit are vital. The coordinated interprofessional team approach can significantly improve patient outcomes and ensure effective diabetes management while mitigating adverse effects and associated complications. Compelling evidence from comprehensive clinical trials underscores the importance of utilizing a team-based care approach involving different healthcare fields. This multidisciplinary approach enhances glycemic control and reduces cardiovascular risks in patients taking antihyperglycemic agents such as canagliflozin.[39]