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.