[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/) › Canagliflozin [Pharmacology](https://durgical.com/en/pharmacology/) · [SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/) # Canagliflozin An SGLT2 inhibitor for type 2 diabetes and diabetic kidney disease, with extra warnings about amputations and fractures. Updated 2026-11-01 - Class: [SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/) - Transporter: Sodium-glucose cotransporter 2 (SGLT2) - ATC code: A10BK02 - WHO Model List of Essential Medicines ⇄**Sodium-glucose cotransporter 2 (SGLT2)**Canagliflozin ⓘ The figure shows canagliflozin bound to human SGLT2 (with MAP17) in the glucose-binding site. **Target in 3D:** Sodium-glucose cotransporter 2 (SGLT2). PDB structure 8HDH (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8HDH) · Drag to rotate · pinch to zoom ## Mechanism of action Canagliflozin blocks SGLT2 in the proximal tubule, so filtered glucose and sodium are lost in the urine and blood glucose falls independently of insulin. It is less selective than dapagliflozin or empagliflozin and also weakly inhibits intestinal SGLT1, which slightly delays glucose absorption after meals. - Binds SGLT2 on the luminal side of the proximal tubule - Filtered glucose and sodium are no longer reabsorbed - Glucose, calories and some fluid leave in the urine - Glucose falls; glomerular pressure and heart load drop ## Pharmacokinetics **Absorption** Oral, once a day. **Metabolism** Mainly glucuronidation. **Elimination** Feces and urine. ## Indications - Type 2 diabetes, and to reduce heart attack, stroke and cardiovascular death in those with heart disease [Type 2 diabetes mellitus →](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) - Diabetic kidney disease, to slow progression and reduce heart failure hospitalization [Chronic kidney disease →](https://durgical.com/en/conditions/chronic-kidney-disease/) ## Adverse effects ### Common - Genital fungal infections (vulvovaginal candidiasis, balanitis) - Urinary tract infections and more frequent urination - Thirst, dizziness and low blood pressure from fluid loss - A small, usually reversible fall in eGFR at the start ### Serious (rare, important) - Diabetic ketoacidosis, which may be euglycemic (glucose near normal): nausea, vomiting, abdominal pain, fast breathing, malaise - Urosepsis and pyelonephritis - Fournier gangrene (necrotizing fasciitis of the perineum): rare, life-threatening - Acute kidney injury with volume depletion - Lower-limb amputation (toe, foot or leg), mostly with prior amputation, vascular disease, neuropathy or foot ulcers - Bone fractures ## Contraindications - Hypersensitivity to the drug - Not used to control glucose in type 1 diabetes, because of ketoacidosis risk ## Key interactions **Insulin or sulfonylureas** Higher risk of hypoglycemia; the other drug is often reduced. **Diuretics (loop or thiazide)** Add to fluid loss and low blood pressure. **Lithium** Serum lithium can fall; levels are checked. **Urine glucose and 1,5-anhydroglucitol tests** Become unreliable for judging glucose control. ## What is monitored - Kidney function and volume status - Daily foot checks in people at risk - HbA1c ## Administration and safety - Oral tablet, once a day, with or without food. - Volume status is checked and corrected before the first dose. - Usually paused before planned surgery and during acute illness or fasting, to prevent ketoacidosis. ## Nursing care - Before: kidney function, blood pressure, hydration, genital and urinary symptoms. - During: signs of ketoacidosis even with normal glucose; ketones are measured if the patient feels unwell. - Teach genital hygiene and to report pain, redness or swelling of the genital or perineal area with fever. - Teach that urine glucose tests will be positive and that fluids matter in hot weather or with vomiting. - Inspect the feet for sores, infection or new pain; report them promptly. ## Pregnancy and breastfeeding Not recommended in the second and third trimesters, based on kidney effects seen in animals; insulin is the usual choice in pregnancy. ## Memory aid Canagliflozin: same sugar leak as the other gliflozins, plus 'feet and bones'. Check the feet, think of falls. ## Test yourself Think of the answer, then tap the question to see it. ## Which two warnings are especially linked to canagliflozin among the gliflozins? Lower-limb amputation and bone fractures. ## Which patients need extra foot care on canagliflozin? Those with previous amputation, peripheral vascular disease, neuropathy or diabetic foot ulcers. ## Which second transporter does canagliflozin weakly block? SGLT1 in the intestine, which slightly delays glucose absorption after meals. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/canagliflozin/) ## Related drugs - [Empagliflozin](https://durgical.com/en/pharmacology/empagliflozin/) - [Dapagliflozin](https://durgical.com/en/pharmacology/dapagliflozin/) ## Related conditions - [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) [← Back to the class: SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Canagliflozin: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a613033.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Structure of human SGLT2-MAP17 complex with Canagliflozin](https://www.rcsb.org/structure/8HDH) (RCSB Protein Data Bank, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=A10BK02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/canagliflozin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/canagliflozin/