National PBM Drug Monograph
National PBM Drug Monograph
Canagliflozin (Invokana)
VHA Pharmacy Benefits Management Strategic Healthcare Group
Medical Advisory Panel and VISN Pharmacist Executives
The purpose of VACO PBM-SHG drug monographs is to provide a comprehensive drug review for making formulary decisions. These documents will be updated when new data warrant additional formulary discussion. Documents will be placed in the Archive section when the information is deemed to be no longer current.
EXECUTIVE SUMMARY
• Canagliflozin (CAN) is the first selective inhibitor of the sodium-glucose co-transporter 2 (SGLT2) to be marketed in the US. Inhibiting SGLT2 at the proximal renal tubule results in reduced reabsorption of filtered glucose and increases urinary glucose excretion. It is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes (T2DM). Canagliflozin has been studied as monotherapy or in combination with metformin (MET), sulfonylureas (SU), metformin +SU, metformin + pioglitazone (PIO), and insulin ± other oral agents.
• The recommended starting dose is 100mg taken once daily before the first meal of the day. If additional glycemic control is needed, the dose may be increased to 300mg once daily in patients who have an estimated GFR (eGFR) of ≥ 60mL/min/1.73m2. The dose of canagliflozin is limited to 100mg daily in patients with moderate renal impairment (eGFR 45 to ................
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