Health Library

Canagliflozin/metformin (By mouth)

Canagliflozin (kan-a-gli-FLOE-zin), Metformin Hydrochloride (met-FOR-min hye-droe-KLOR-ide)

Treats type 2 diabetes. Also lowers the risk of death, end stage kidney disease, heart attack, or stroke in patients with type 2 diabetes and heart or blood vessel problems.

Brand Name(s):

Invokamet, Invokamet XR

When This Medicine Should Not Be Used:

How to Use This Medicine:

Tablet, Long Acting Tablet

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
• It is best to take this medicine with food or milk.
• Swallow the extended-release tablet whole. Do not crush, break, or chew it. Take it with the morning meal.
• If you take the extended-release tablet, part of the tablet may pass into your stools. This is normal and is nothing to worry about.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in the original container to protect it from moisture. You may also store the tablets in a pill box or pill organizer for up to 30 days only. Store at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how canagliflozin/metformin works. Tell your doctor if you are using any of the following:
  • Acetazolamide, cimetidine, digoxin, dichlorphenamide, dolutegravir, isoniazid, lithium, morphine, nicotinic acid, quinine, ranitidine, ranolazine, rifampin, ritonavir, trimethoprim, vandetanib
  • Birth control pills
  • Blood pressure medicine
  • Diuretic (water pill, including amiloride, triamterene)
  • Insulin or other diabetes medicine
  • Medicine for heart rhythm changes (including procainamide, quinidine)
  • Medicine to treat seizures (including phenobarbital, phenytoin, topiramate, zonisamide)
  • NSAID pain or arthritis medicine (including aspirin, celecoxib, diclofenac, ibuprofen, naproxen)
  • Thyroid medicine
• Several other medicines may affect your blood sugar levels. Closely monitor your blood sugar levels when you start or stop another medicine while you are using canagliflozin/metformin.
• If you are taking an evening dose of metformin extended-release tablets, you should skip the last dose before starting treatment with this medicine the following morning.
• Limit the amount of alcohol you drink. Heavy alcohol use increases your risk for lactic acidosis.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant. Do not use this medicine during the second and third part of your pregnancy, unless your doctor tells you to. If you had problems ovulating or have irregular periods, this medicine may cause you to ovulate, which could lead to pregnancy if you are sexually active. Talk to your doctor about effective birth control while you are using this medicine.
• Do not breastfeed during treatment with this medicine.
• Tell your doctor if you have kidney disease, liver disease, heart disease, blood vessel disease, adrenal or pituitary gland disease, heart failure, vitamin B12 deficiency, nerve problems, type 1 diabetes, an infection, or a history of pancreas problems, genital yeast or urinary tract infections, leg surgery, or foot ulcers. Tell your doctor if you are on a low-salt diet, if you drink alcohol, or if you are having surgery or other procedures.
• This medicine may cause the following problems:
  • Lactic acidosis (too much acid in the blood)
  • Increased risk for leg, toe, or midfoot amputation (removal)
  • Low blood pressure
  • Ketoacidosis (high ketones and acid in the blood), which can be life-threatening
  • Kidney problems
  • Low blood sugar levels, when used with other diabetes medicines
  • Increased risk of genital yeast or urinary tract infections (including pyelonephritis, urosepsis)
  • Fournier's gangrene (skin or tissue damage of the area between the anus and genitals)
  • Increased risk for broken bones
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may interact with the dye used for an x-ray or a CT scan.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Change in how much or how often you urinate, trouble urinating, painful or difficult urination, lower back or side pain, chills
• Confusion, severe weakness, uneven heartbeat, numbness in your hands, feet, or lips
• Fast or trouble breathing, stomach pain, nausea, vomiting, severe weakness, tiredness
• Increased hunger, headache, confusion, shaking, trembling, sweating
• Lightheadedness, dizziness, fainting
• Pain, tenderness, redness, or swelling of the area between the anus and genitals, fever, unusual tiredness or weakness
• Pain, tenderness, sores or ulcers, or infections on the leg or foot
• Rapid weight gain, swelling in your hands, ankles, or feet

If you notice these less serious side effects, talk with your doctor:

• Redness, itching, pain, or swelling of the penis, bad-smelling discharge from the penis
• White or yellow vaginal discharge, vaginal itching or odor

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 9/6/2024