Nice | Canagliflozin in Type 2 diabetes

CanagliflozinThis new guideline from NICE outlines when canagliflozin can be used. This is an SGLT2 inhibitor (selective sodium-glucose cotransporter-2). It blocks reabsorption of glucose in the kidneys, so increases secretion. It's trade name is Invokana. Another one of these drugs (Dapagliflozin) was approved last year.

When can it be used?

  • ¬†As a second drug added on to metformin if a sulfonylurea can't be used.
  • ¬†As a third drug added on to metformin with either a sulfonylurea or another drug.
  • ¬†Added onto insulin with or without other drugs.


  • You have to beware their renal function. Don't start it if eGFR < 60.
  • If the patient is¬†already on it and their eGFR drops to below 60, but they are tolerating it, then decrease the dose to 100mg, but it can continue. If the eGFR drops < 45, then it should be stopped.

I’m a freelance GP locum in Winchester & Southampton.

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