Main research findings

Canagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that has been shown to be effective in lowering blood glucose, as well as blood pressure, body weight, and albuminuria in patients with type 2 diabetes mellitus (T2DM). 16

Canagliflozin has been shown to reduce the risk of cardiovascular events, including heart failure, cardiovascular death, and myocardial infarction. 16 20

However, there are potential risks associated with the use of canagliflozin. One of the most common side effects is genital mycotic infections. 17

Canagliflozin is associated with an increased risk of lower limb amputation. 16

Canagliflozin has been linked to an increased risk of fractures. 17

Reasons for side effects

The side effects of canagliflozin are likely related to its mechanism of action. Canagliflozin works by inhibiting the SGLT2 transporter in the kidneys, which causes the body to excrete more glucose in the urine. This increased excretion of glucose can lead to a number of side effects, including genital mycotic infections and dehydration. 17

Common side effects

Genital mycotic infections

Genital mycotic infections, particularly those caused by Candida species, are the most frequently reported side effect of canagliflozin. 17 20 18

Lower limb amputation

There is an increased risk of lower limb amputation associated with canagliflozin. 16 17

Hypoglycemia

Hypoglycemia can occur if canagliflozin is used in combination with agents that can cause hypoglycemia, such as insulin or sulfonylureas. 17

Volume depletion and hypotension

Volume depletion and hypotension are infrequent side effects and can be minimized by adjusting diuretic and antihypertensive treatment in patients at risk. 17

Acute renal failure or kidney injury

While early observational studies suggested an increased risk of acute kidney injury, more recent randomized controlled trials and observational studies have shown a decreased incidence of acute kidney injury in canagliflozin-treated patients compared to placebo or other glucose-lowering agents. 17

Fractures

Canagliflozin has been associated with an increased incidence of fractures. 17

Diabetic ketoacidosis (DKA)

Canagliflozin may increase the risk of DKA, especially in patients with type 1 diabetes or in those who are insulin deficient. 1 4 24

Countermeasures for side effects

Genital mycotic infections

To prevent genital mycotic infections, it is important to maintain hygiene. If symptoms occur, you should see a doctor and receive appropriate treatment. 17

Lower limb amputation

To reduce the risk of lower limb amputation, it is important to manage diabetes well and seek medical attention immediately if you experience any foot abnormalities or pain. 16

Hypoglycemia

To prevent hypoglycemia, it is important to monitor blood glucose levels regularly and adjust medication dosages as needed. 17

Volume depletion and hypotension

Patients at risk of volume depletion and hypotension should have their diuretic and antihypertensive medications adjusted. 17

Acute renal failure or kidney injury

Patients with pre-existing kidney disease should be closely monitored for signs of kidney dysfunction. 17

Fractures

Patients taking canagliflozin should receive appropriate counseling on measures to reduce fracture risk, such as increasing calcium and vitamin D intake and engaging in weight-bearing exercise. 17

Diabetic ketoacidosis (DKA)

Patients taking canagliflozin should be educated about the signs and symptoms of DKA and advised to seek medical attention promptly if they experience these symptoms. 1 4 24

Comparison between studies

Common points of the studies

Multiple studies have consistently shown that canagliflozin can effectively reduce blood glucose levels. 20 16 17

Canagliflozin has been shown to have beneficial effects on cardiovascular health, including reducing the risk of heart failure and cardiovascular death. 16 20 21 5

Differences between studies

The incidence of some side effects, such as genital mycotic infections and lower limb amputation, can vary between studies. 17 20 16

The risk of DKA associated with canagliflozin has been a topic of debate. While some studies have shown an increased risk of DKA, particularly in patients with type 1 diabetes, others have not reported an increased risk. 1 4 24

Notes on application to real life

Canagliflozin is a valuable treatment option for type 2 diabetes, but it is important to weigh the potential benefits against the risks. Patients should be aware of the potential side effects of canagliflozin and discuss these concerns with their healthcare providers. 16 20 17 22

Close monitoring of blood glucose levels and other relevant health parameters is essential for patients taking canagliflozin. 17 22

Limitations of current research

Further research is needed to fully understand the long-term safety and efficacy of canagliflozin. 16 20

More research is needed to better understand the risk of DKA associated with canagliflozin, particularly in different patient populations. 1 4 24

Future research directions

Future research should focus on better understanding the mechanisms underlying the side effects of canagliflozin and developing strategies to mitigate these risks. 16 20 17

Additional studies are needed to assess the long-term effects of canagliflozin on bone health and to determine the optimal strategies for managing fracture risk. 17

Conclusion

Canagliflozin is an effective medication for managing type 2 diabetes, offering benefits in reducing blood glucose levels and cardiovascular risk. However, it is crucial to be aware of the potential side effects and engage in open communication with healthcare providers to make informed decisions about treatment. 16 20 17 22