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Invokamet XR
canagliflozin/ metformin
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle with nonspecific symptoms including malaise, myalgias, respiratory distress, somnolence, abdominal pain; lab findings include lactate >5 mmol/L, anion gap acidosis (without evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may include renal impairment, concomitant meds, patients 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immediately if lactic acidosis suspected, hospitalize patient and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: TAB: 50 mg IR/500 mg ER, 50 mg IR/1000 mg ER, 150 mg IR/500 mg ER, 150 mg IR/1000 mg ER
diabetes mellitus, type 2
- [tx-naive patients]
- Dose: 2 tabs PO qam; Start: 100 mg/1000 mg PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function; see canagliflozin for cardiovascular event risk reduction use or kidney disease progression and cardiovascular-associated risk reduction use
- [conversion from canagliflozin plus metformin]
- Dose: 2 tabs PO qam; Start: current total daily canagliflozin dose plus current total daily metformin dose PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function; see canagliflozin for cardiovascular event risk reduction use or kidney disease progression and cardiovascular-associated risk reduction use
- [conversion from canagliflozin]
- Dose: 2 tabs PO qam; Start: current total daily canagliflozin dose plus metformin 1000 mg PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function; see canagliflozin for cardiovascular event risk reduction use or kidney disease progression and cardiovascular-associated risk reduction use
- [conversion from metformin]
- Dose: 2 tabs PO qam; Start: canagliflozin 100 mg plus current total daily metformin dose PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function; see canagliflozin for cardiovascular event risk reduction use or kidney disease progression and cardiovascular-associated risk reduction use
renal dosing
- [see below]
- eGFR 45-59: max canagliflozin dose 100 mg/day; eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit, max canagliflozin dose 100 mg/day if eGFR 30-44 during tx
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
- Dosage forms: TAB: 50 mg IR/500 mg ER, 50 mg IR/1000 mg ER, 150 mg IR/500 mg ER, 150 mg IR/1000 mg ER
diabetes mellitus, type 2
- [tx-naive patients, 10 yo and older]
- Dose: 2 tabs PO qam; Start: 100 mg/1000 mg PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from canagliflozin plus metformin, 10 yo and older]
- Dose: 2 tabs PO qam; Start: current total daily canagliflozin dose plus current total daily metformin dose PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from canagliflozin, 10 yo and older]
- Dose: 2 tabs PO qam; Start: current total daily canagliflozin dose plus metformin 1000 mg PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from metformin, 10 yo and older]
- Dose: 2 tabs PO qam; Start: canagliflozin 100 mg plus current total daily metformin dose PO qam; Max: 300 mg/2000 mg/day; Info: give with meals; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
renal dosing
- [see below]
- eGFR 45-59: max canagliflozin dose 100 mg/day; eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit, max canagliflozin dose 100 mg/day if eGFR 30-44 during tx
- HD/PD: contraindicated
hepatic dosing
- [see below]
- hepatic impairment: avoid use