Canagliflozin Hydrochloride (Canaglu) is a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor, mainly used for the treatment of patients with type 2 diabetes mellitus and those with diabetes mellitus complicated by chronic kidney disease (non-end-stage).
Precautions for Administration of Canagliflozin Hydrochloride (Canaglu)
Contraindicated Populations
Patients allergic to any component of this medication.
Patients with severe diabetic ketoacidosis, diabetic coma, or pre-coma.
Patients with severe infections, those in the perioperative period, or those with severe trauma.
Patients with type 1 diabetes mellitus.
Patients with end-stage renal failure or those receiving dialysis (when used for blood glucose-lowering purposes).
Pregnant women and women who may become pregnant.
Lactating women (it is recommended to discontinue breastfeeding during medication use).
Patients with Hepatic Impairment
Safety data are lacking for patients with Child-Pugh Class C hepatic impairment (score > 9).
Patients with mild to moderate hepatic impairment require close monitoring.
Elderly Patients
Age-related decline in physiological function increases the risk of dehydration.
Treatment should start with a low dose, followed by gradual dose titration.
Diabetic Ketoacidosis
May occur without significant hyperglycemia (blood glucose < 250 mg/dL).
Be alert to symptoms such as nausea, vomiting, abdominal pain, excessive thirst, and fatigue.
High-risk situations: insulin dose reduction, very low-carbohydrate diet, infection, etc.
Dehydration and Hypotension
The diuretic effect of the medication may lead to reduced body fluids, and the risk is higher in elderly patients.
Moderate increase in fluid intake is recommended.
Monitor blood pressure, especially when used in combination with diuretics.
Infection Risk
Increased risk of urinary tract and genital infections (including rare but severe Fournier's gangrene of the perineum).
Educate patients to pay attention to personal hygiene and recognize infection symptoms.
Treatment Monitoring for Canagliflozin Hydrochloride (Canaglu)
Blood Glucose-Related Monitoring
Measure glycated hemoglobin (HbA1c) once every 3 months.
Regularly monitor fasting blood glucose and postprandial blood glucose.
Note: Urinary glucose and serum 1,5-anhydroglucitol (1,5-AG) cannot reflect blood glucose control status.
Renal Function Monitoring
Measure estimated glomerular filtration rate (eGFR) at baseline and regularly (every 3–6 months is recommended).
Consider discontinuing the medication if eGFR persists at < 45 mL/min/1.73m².
Monitor the urine protein/creatinine ratio.
Volume Status Monitoring
Regular blood pressure measurement.
Pay attention to dehydration symptoms (such as thirst, dizziness, oliguria, etc.).
Ketone Monitoring
Immediately measure blood/urine ketones when acidosis is suspected.
Strengthen monitoring during high-risk periods (e.g., surgery, stressful conditions).
Infection Monitoring
Regular urine routine examinations.
Pay attention to symptoms of the genitourinary system.
Laboratory Monitoring
Regularly check serum potassium levels (especially when used in combination with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers [ACEI/ARB]).
Monitor hematocrit (may increase).
Conduct liver function tests (especially for patients with abnormal baseline liver function).
