Drug Interactions With Canagliflozin
The following sections explain in detail the potentially negative interactions that can occur when canagliflozin is combined with any of the drugs listed above.
Combining canagliflozin with ACE inhibitors can increase your risk of high potassium levels in your blood (hyperkalemia) and low blood pressure. Your healthcare provider should check your potassium levels and your blood pressure regularly.
Combining canagliflozin with an angiotensin II receptor blocker (ARB) can increase your risk of high potassium levels in your blood (hyperkalemia) and low blood pressure. Your healthcare provider should check your potassium levels and your blood pressure regularly.
Blood Pressure Medicine
Canagliflozin typically lowers blood pressure a small amount. When taking canagliflozin with a high blood pressure medication, your blood pressure may become too low. Check with your healthcare provider before taking canagliflozin with a blood pressure medication. He or she should monitor your blood pressure carefully, and adjust the dosage of one or both medications as necessary.
Canagliflozin can increase the level of digoxin in the blood, and should be used carefully in people taking digoxin. Also, this combination could lead to dangerously high potassium levels in the blood. Your healthcare provider should monitor your digoxin levels and your potassium levels closely.
Canagliflozin has somewhat of a diuretic effect. Combining it with a diuretic medication increases the risk for low blood pressure, dehydration, and fainting. In addition, potassium-sparing diuretics (amiloride, spironolactone, and triamterene) taken in combination with canagliflozin increase the risk for high blood potassium (hyperkalemia). Check with your healthcare provider before taking canagliflozin with a diuretic. You may need extra monitoring and, in some cases, one of the two medications may need to be stopped.
Other Diabetes Medications
Combining canagliflozin with other diabetes medications may increase the risk of low blood sugar (hypoglycemia). However, many people need to take two or more diabetes medications in order to control their blood sugar levels. If you are having trouble with your blood sugar levels dipping too low, please consult your healthcare provider right away.
Please note that the risk of low blood sugar with canagliflozin is greatest when combined with insulin medications or sulfonylureas, such as:
- Chlorpropamide (Diabinese®)
- Glimepiride (Amaryl®)
- Glipizide (Glucotrol®, Glucotrol XL®)
- Glyburide (DiaBeta®, Micronase®, Glynase®)
- Tolazamide (Tolinase®)
- Tolbutamide (Orinase®).
In general, potassium-containing products should not be used with canagliflozin, due to the risk of high potassium levels (hyperkalemia), without the specific approval of your healthcare provider. This is particularly important for people with kidney impairment.
UGT Enzyme Inducers
UGT enzyme inducers can decrease the amount of canagliflozin in the bloodstream by about 50 percent, perhaps making it less effective. As long as your kidney function is adequate, your healthcare provider can account for this interaction by increasing your canagliflozin dosage to 300 mg, if necessary.
However, no dose increase is recommended if you are already taking the maximum dosage, which is 300 mg for people with normal or mildly impaired kidney function or 100 mg for people with moderate kidney impairment.