Canagliflozin

1) Diabetic ketoacidosis (DKA) - increase in ketones in your blood or urine

DKA is a rare but serious side effect associated with this medication. You should stop taking your medication and check with your doctor immediately if you experience these symptoms:

• Pain in the stomach , abdominal area
• Nausea or vomiting 
• Feeling confused, tired or unusually sleepy 
• Difficulty breathing (shortness of breath)
• Feeling very thirsty
• Sweet fruity smell in your breath

To lower the chances of DKA, make sure to drink enough water everyday. Extended periods of fasting or large reductions in food intake may also increase the chances of DKA happening.

2) Genital infections

This medication is also very rarely associated with a serious bacterial infection in the genital region. You should stop the medication and see a doctor immediately if you develop fever and pain, redness or swelling in your genitals or in the area between your genitals and rectum. To minimise the chances of this happening, always maintain good genital hygiene.

3) If you experience any ulcers or signs of infections on your feet (e.g. pain or tenderness, redness, swollen appearance, feeling of warmth), please stop the medication and see a doctor.

If you have any of the symptoms below, you should check with your doctor. 

1) Yeast infections

Some female patients may have a higher chance of getting vaginal yeast infections. Symptoms include white or yellowish vaginal discharge, bad smelling discharge or itch at the vaginal area. 

Some male patients may have a higher chance of getting yeast infection of the penis. Symptoms include rash, redness, itch or swelling of the penis, bad smelling discharge from the penis or pain around the penis. 

If you find redness, swelling of or around the genital area, have a fever and are generally feeling unwell, please stop the medication and see a doctor.

2) Urinary tract infection

This medication may increase the chance of getting a urinary tract infection. Symptoms include a burning feeling when you pass urine, the need to pass urine more often, feeling like you need to pass urine more often,or if you see blood in your urine. 

3) Low blood pressure

You may feel giddy or lightheaded, especially when you get up from a lying or sitting position. This is more likely to happen in the morning or when you first get out of bed. Getting up slowly may help but if the problem continues, check with your doctor. 

4) Dehydration (not having enough water in the body)

You might experience dehydration as it removes the excess sugar in your body through your urine. You should take extra 1-2 glasses of water every day unless your doctor told you that you need to control the amount of liquid you take. 

5) Low blood sugar

Symptoms of low blood sugar are weakness, dizziness, hunger, sweating, trembling, blurred vision, unsteady walk or fast heartbeat.

If you experience any of these low blood sugar symptoms, do the following immediately: 

Step 1: Check your blood sugar level with a home blood sugar meter (glucometer) if available. If your blood sugar level is less than 4 mmol/L, take 15 grams of sugar such as:

• 3 glucose tablets or 
• Half a glass of fruit juice or 
• 3 teaspoons of sugar, honey or syrup 

Step 2:  You should feel better in about 15 minutes. If you have a home blood sugar meter, you should check your blood sugar level again. 

Step 3: If your blood sugar level is still less than 4 mmol/L or you still have symptoms of low blood sugar, you should take another 15 grams of sugar.

If your symptoms still do not get better, see a doctor or go to the hospital immediately.

Inform your doctor if: 

• you are allergic to this medication or any of the other ingredients of this medication
• you are pregnant, planning to become pregnant, or breastfeeding
• you have a heart condition, kidney or liver problem
• you drink alcohol often
• you have suffered from diabetic ketoacidosis (presence of ketones in blood or urine) in the past
• you have a history of urinary tract infections or bladder cancer
• you are planned to go for any surgery or procedure as you may need to stop the medication temporarily before that

​Avoid taking alcohol with this medication.

It is taken once a day. You may take this medication with or without food.

If you forget to take a dose, take it as soon as you remember. Then take your next dose at the usual time. 

If it is less than 12 hours until your next dose, skip the missed dose and take your next dose at the usual time. Do not take two doses to make up for the missed dose.

​If you take more than the recommended dose, please seek medical advice immediately.

​Pack this medicine into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. 

You are encouraged to check your blood sugar levels with a home blood sugar meter as instructed by your healthcare professional.

There is a 2 times increased risk of lower limb amputations (most commonly, surgical removal of the toe and midfoot) linked to the use of Canagliflozin in 2 large trials in patients with known heart disease. Monitor for any infection, new pain or tenderness, sores or ulcers involving the lower limbs, and consult your healthcare professional if these complications occur.