NICE guidance - canagliflozin in combination therapy for treating type 2 diabetes

Last reviewed 02/2022

Canagliflozin is an orally administered selective sodium-glucose cotransporter-2 (SGLT-2) inhibitor. It lowers blood glucose in people with type 2 diabetes by blocking the reabsorption of glucose in the kidneys and promoting excretion of excess glucose in the urine.

Adverse effects:

• summary of product characteristics states the following adverse reactions for canagliflozin as the most commonly reported: hypoglycaemia in combination with insulin or a sulfonylurea, vulvovaginal candidiasis, urinary tract infection, and polyuria or pollakiuria (that is, urinary frequency). For full details of adverse reactions and contraindications, see the summary of product characteristics

NICE have stated that (1)

Canagliflozin in a dual therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if:

• a sulfonylurea is contraindicated or not tolerated or the person is at significant risk of hypoglycaemia or its consequences

Canagliflozin in a triple therapy regimen is recommended as an option for treating type 2 diabetes in combination with:

• metformin and a sulfonylurea or
• metformin and a thiazolidinedione

Canagliflozin in combination with insulin with or without other antidiabetic drugs is recommended as an option for treating type 2 diabetes

People currently receiving treatment initiated within the NHS with canagliflozin that is not recommended for them by NICE in this guidance should be able to continue treatment until they and their NHS clinician consider it appropriate to stop. Canagliflozin in combination therapy for treating type 2 diabetes

Notes:

• canagliflozin and renal function
  • recommended starting dosage of canagliflozin is 100 mg once daily. In patients tolerating canagliflozin 100 mg once daily who have an estimated glomerular filtration rate (eGFR) of at least 60 ml/minute/1.73 m2 or creatinine clearance (CrCl) of at least 60 ml/minute and need tighter glycaemic control, the dosage can be increased to 300 mg once daily
  • for patients with renal impairment, the summary of product characteristics notes that canagliflozin should not be initiated in patients with an eGFR of less than 60 ml/minute/1.73m2 or CrCl of less than 60 ml/minutes
    • in patients tolerating canagliflozin whose eGFR falls persistently below 60 ml/minute/ 1.73 m2 or whose CrCl persistently falls below 60 ml/minute, the dose of canagliflozin should be adjusted to or maintained at 100 mg once daily
    • canagliflozin should be discontinued when eGFR is persistently below 45 ml/ minute/1.73 m2 or CrCl is persistently below 45 ml/minute

Reference:

• NICE (June 2014). Canagliflozin in combination therapy for treating type 2 diabetes.