Canagliflozin (brand name Invokana) is an SGLT2 inhibitor used mainly for type 2 diabetes. It lowers blood sugar by making your kidneys remove extra glucose into the urine. People also notice weight loss and a drop in blood pressure. Large trials found it can lower the risk of heart failure hospitalizations and help protect the kidneys in people with diabetic kidney disease.
Canagliflozin blocks the SGLT2 protein in kidney tubules so less glucose is reabsorbed. Because it works through the kidneys, it helps even when insulin is less effective. That makes it useful for people with insulin resistance or overweight. But its sugar-lowering effect falls off if kidney function is poor — it’s usually not started if eGFR is below 30 mL/min/1.73 m² and dose adjustments are needed at lower eGFRs.
Typical dosing is 100 mg once daily before the first meal. If tolerated and kidney function allows, doctors may increase to 300 mg once daily. Your prescriber will check your eGFR before starting and during treatment to be safe.
Common side effects are more urination, thirst, and genital yeast infections (both men and women). Urinary tract infections can happen too. Drink enough fluids, practice good hygiene, and tell your clinician if you get fever, bad pain, or persistent urinary symptoms.
There are rarer but serious risks to watch for. Canagliflozin has been linked to cases of diabetic ketoacidosis that can occur with only mildly elevated blood glucose (euglycemic DKA). Symptoms include nausea, vomiting, stomach pain, fast breathing, or unusual tiredness — seek care quickly. Also, some studies reported a higher risk of lower limb amputations; check your feet daily, treat sores or infections early, and report poor circulation or numbness.
Volume depletion and low blood pressure can occur, especially if you take diuretics. That can lead to dizziness or kidney injury. If you’re on insulin or sulfonylureas, your risk of low blood sugar rises, so your doses may need lowering. Stop canagliflozin before planned surgeries or during severe illness or dehydration.
Do not use canagliflozin in pregnancy or while breastfeeding. It’s not approved for children under 18. Always tell your doctor about other meds you take, especially blood pressure drugs, diuretics, and diabetes medicines that increase hypoglycemia risk.
Quick checklist: confirm kidney function before starting, learn DKA symptoms, watch for genital infections, check feet daily, avoid dehydration, and stop the drug before surgery. Always buy prescriptions from a licensed pharmacy and use a prescription — don’t risk counterfeit drugs. If anything new or worrying appears, call your healthcare provider right away.
