canagliflozin hemihydrate + metformin at a glance
Medicine class
SGLT2 inhibitor plus biguanide
Usual role
Improves blood-glucose control in adults with type 2 diabetes
Administration
Swallow the film-coated tablet whole with a meal to reduce stomach-related effects
Urine glucose
Urine will usually test positive for glucose because canagliflozin removes glucose through the kidneys
What is canagliflozin hemihydrate + metformin used for?
Licensed for adults with type 2 diabetes as an adjunct to diet and exercise.
When the maximally tolerated amount of metformin alone has not provided sufficient control.
With other diabetes treatments when metformin and those treatments have not provided sufficient control.
To replace canagliflozin and metformin taken as separate tablets.
How does canagliflozin hemihydrate + metformin work?
Canagliflozin blocks SGLT2 in the kidneys so more glucose leaves in urine. Metformin reduces glucose production by the liver and improves the body’s response to insulin.
canagliflozin hemihydrate + metformin preparations and strengths
Tablet
Route: Oral
Strengths: 50 mg + 1000 mg, 50 mg + 850 mg
How to take canagliflozin hemihydrate + metformin
Follow the prescribed product instructions.
Swallow tablets whole.
Take with a meal to reduce nausea, diarrhoea and other stomach effects.
During significant vomiting, diarrhoea, fever or reduced fluid intake, temporarily stop the tablets and contact a healthcare professional because dehydration increases the risks of ketoacidosis, kidney impairment and lactic acidosis.
canagliflozin hemihydrate + metformin side effects
Common or expected effects
- Nausea, vomiting, diarrhoea, abdominal discomfort or reduced appetite
- Genital thrush
- Urinary tract infection
- Passing urine more often or in larger amounts
- Thirst or constipation
- Taste disturbance
- Reduced vitamin B12 levels during longer-term metformin use
- Low blood glucose when combined with insulin or a sulphonylurea
Get urgent medical advice
- Diabetic ketoacidosis, which may occur even when blood glucose is not very high
- Lactic acidosis
- Severe allergic reaction
- Severe dehydration, fainting or passing very little urine
- Complicated urinary infection
- Fournier’s gangrene
- A new foot ulcer, infection, gangrene or other serious lower-limb complication
canagliflozin hemihydrate + metformin in pregnancy
The combined product should not be used during pregnancy because canagliflozin is unsuitable. Contact the diabetes team promptly when planning pregnancy or if pregnancy occurs so treatment can be reviewed.
canagliflozin hemihydrate + metformin while breastfeeding
The combined product should not be used while breastfeeding because risk from canagliflozin to the infant cannot be excluded. Metformin alone can generally be used, so the prescriber should review alternatives.
canagliflozin hemihydrate + metformin interactions
Ask a prescriber or pharmacist to review all other medicines, including non-prescription and herbal products.
Insulin or sulphonylureas
Increased risk of hypoglycaemia.
Diuretics, especially loop diuretics
Additive fluid loss can increase dehydration, low blood pressure, kidney impairment and lactic-acidosis risk.
NSAIDs, ACE inhibitors or angiotensin-II receptor blockers
Impaired renal function can increase metformin accumulation and lactic-acidosis risk, particularly during dehydration.
Common questions about canagliflozin hemihydrate + metformin
Answers are fully visible for fast scanning and source review.
Can it cause low blood sugar?
It does not usually cause hypoglycaemia by itself, but the risk rises with insulin or a sulphonylurea.
Why is glucose found in urine?
Canagliflozin prevents the kidneys from returning some filtered glucose to the bloodstream, so glucose in urine is expected.
Can ketoacidosis occur without very high blood sugar?
Yes. Symptoms require urgent ketone assessment even when glucose is only moderately raised or near normal.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.