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canagliflozin and metformin

Pronunciation: KAN a gli FLOE zin and met FOR min

Brand: Invokamet, Invokamet XR

What is the most important information I should know about canagliflozin and metformin?

You should not use this medicine if you have severe kidney disease or diabetic ketoacidosis (call your doctor for treatment).

You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired.

What is canagliflozin and metformin?

Canagliflozin and metformin are oral diabetes medicines that help control blood sugar levels.

Canagliflozin and metformin is a combination medicine used with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.

Canagliflozin and metformin may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking canagliflozin and metformin?

You should not use this medicine if you are allergic to canagliflozin (Invokana) or metformin, or if you have severe kidney disease or diabetic ketoacidosis (call your doctor for treatment with insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking this medicine.

Tell your doctor if you have ever had:

  • liver or kidney disease;
  • bladder infections or other urination problems;
  • heart disease, congestive heart failure;
  • blood circulation problems;
  • nerve problems caused by diabetes;
  • a diabetic foot ulcer or amputation;
  • a pancreas disorder or surgery;
  • an electrolyte imbalance (such as high levels of potassium in your blood); or
  • if you are on a low salt diet.

You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk.

Tell your doctor right away if you become pregnant. Canagliflozin may harm the unborn baby if you take this medicine during your second or third trimester.

Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk.

You should not breast-feed while using this medicine.

Canagliflozin and metformin is not approved for use by anyone younger than 18 years old.

How should I take canagliflozin and metformin?

Your doctor may perform kidney function tests before you start taking canagliflozin and metformin.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, and feeling shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Your doctor may have you take extra vitamin B12 while you are taking canagliflozin and metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine, which can lead to severely low blood pressure or a serious electrolyte imbalance.

If you need surgery or medical tests, tell any doctor who treats you that you are using canagliflozin and metformin.

Canagliflozin and metformin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store tablets in their original container at room temperature, away from moisture and heat. Do not keep canagliflozin and metformin tablets in a daily pill box for longer than 30 days.

What happens if I miss a dose?

Take the medicine (with food) as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. You may have severely low blood sugar (extreme weakness, nausea, tremors, sweating, confusion, trouble speaking, fast heartbeats, or seizure).

What should I avoid while taking canagliflozin and metformin?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis.

What are the possible side effects of canagliflozin and metformin?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Mild symptoms of lactic acidosis may worsen over time, and this condition can be fatal. Get emergency medical help if you have: unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired.

Call your doctor at once if you have:

  • new pain, tenderness, sores, ulcers, or infections in your legs or feet;
  • a light-headed feeling, like you might pass out;
  • high potassium level --nausea, weakness, tingly feeling, chest pain, irregular heartbeats, muscle weakness;
  • ketoacidosis (too much acid in the blood) --nausea, vomiting, stomach pain, confusion, unusual drowsiness, or trouble breathing;
  • kidney problems --little or no urination, swelling in your feet or ankles, feeling tired or short of breath;
  • signs of a bladder infection --pain or burning when you urinate, urine that looks cloudy, pain in pelvis or back; or
  • signs of a genital infection (penis or vagina) --pain, burning, itching, rash, redness, odor, or discharge.

Older adults may be more likely to have kidney problems while taking this medicine.

You may be more likely to have a broken bone while using medicine that contains canagliflozin. Talk with your doctor about ways to keep your bones healthy.

Common side effects may include:

  • urinating more than usual;
  • headache, weakness;
  • gas, stomach pain, indigestion;
  • nausea, vomiting; or
  • diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect canagliflozin and metformin?

Tell your doctor about all your other medicines, especially:

  • digoxin (digitalis, Lanoxin);
  • a diuretic or "water pill";
  • insulin or other oral diabetes medications;
  • rifampin;
  • ritonavir; or
  • seizure medicine --phenobarbital, phenytoin.

This list is not complete. Other drugs may affect canagliflozin and metformin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your pharmacist can provide more information about canagliflozin and metformin.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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