From the Rxisk Org website:
Warnings & Pharmacology – Warnings, General
CONTRAINDICATIONS:
History of serious hypersensitivity to canagliflozin, severe renal impairment (eGFR less than 30 mL/min/1.73 m2), end stage renal disease, patients on dialysis, patients with type 1 diabetes mellitus, treatment of diabetic ketoacidosis
WARNINGS/PRECAUTIONS:
CARDIOVASCULAR:
Hypotension:
-Canagliflozin causes intravascular volume contraction
-Symptomatic hypotension can occur in patients with impaired renal function, elderly, patients on diuretics or medication interfering with renin-angiotensin-aldosterone system, patients with low systolic blood pressure
Recommendations:
-Assess and correct volume status
-Monitor for intravascular volume contraction
ENDOCRINE:
Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues:
-Canagliflozin can increase risk of hypoglycemia when combined with insulin or insulin secretagogues.
Recommendation:
-A lower dose of insulin or insulin secretagogue may be required
GENITOURINARY:
Genital Mycotic Infections:
-Canaglifozin increases the risk of genital mycotic infections specifically in patients with a history of these infections and uncircumcised males
Recommendations:
-Monitor and treat with oral or topical antifungal and anti-microbial agents as deemed appropriate
HYPERSENSITIVITY:
-Some serious hypersensitivity reactions were reported, generally occurring within hours to days of starting treatment
Recommendations:
-If hypersensitivity occurs, discontinue treatment, treat appropriately, monitor until signs and symptoms resolve
INCREASES IN LOW-DENSITY LIPOPROTEIN (LDL-C):
-Dose-related increases in LDL-C can occur
Recommendation:
-Monitor LDL-C and treat appropriately after starting treatment
METABOLIC:
Hyperkalemia:
-Canagliflozin can lead to hyperkalemia particularly in patients with moderate renal impairment taking medications that interfere with potassium excretions or the renin-angiotensin-aldosterone system
Recommendations:
-Monitor serum potassium levels after starting treatment in patients with conditions predisposing them to hyperkalemia
RENAL:
Impairment in Renal Function:
-Increases serum creatinine and decreases eGFR
-Renal function abnormalities can occur after starting treatment
Recommendation:
-More frequent monitoring of renal function in patients with eGFR below 60 mL/min/1.73 m2
SPECIAL POPULATIONS:
-ELDERLY PATIENTS: Higher incidence of adverse reactions related to reduced intravascular volume (hypotension, postural dizziness, orthostatic hypotension, syncope, dehydration) especially with the 300 mg daily dose.
-PEDIATRIC PATIENTS: Safety and efficacy have not been established in patients younger than 18 years.
LABORATORY CONSIDERATIONS: Dose-related increases in LDL-C