This 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.