Teneligliptin Hydrobromide/Canagliflozin Combination Tablets (Canalia) is a fixed-dose combination preparation of a DPP-4 inhibitor and an SGLT2 inhibitor developed by Mitsubishi Tanabe Pharma (Japan). It was approved for marketing in Japan in 2017. This medication exerts a synergistic blood glucose-lowering effect through a dual mechanism; however, its clinical use must strictly adhere to safety guidelines.

Precautions for Administration of Teneligliptin Hydrobromide/Canagliflozin Combination Tablets (Canalia)

Prevention and Control of Hypoglycemia Risk

This medication may cause hypoglycemia, especially when co-administered with insulin, sulfonylureas, or rapid-acting insulin secretagogues.

Patients should receive education on recognizing hypoglycemia symptoms and corresponding management methods. Immediate intervention is required if symptoms such as palpitations, cold sweats, or confusion occur.

Prevention of Dehydration and Electrolyte Imbalance

The diuretic effect of canagliflozin may lead to polyuria and fluid loss. The risk is higher in elderly patients, patients with renal impairment, or those co-administered with diuretics.

Patients should be instructed to maintain adequate fluid intake and closely monitor for signs of dehydration, such as thirst, dry skin, and decreased blood pressure.

Attention should be paid to monitoring electrolyte levels, including serum potassium and sodium.

Management of Infection Risk

This medication may increase the risk of urinary tract infections and genital infections; in severe cases, these infections may progress to pyelonephritis, necrotizing fasciitis, or even sepsis.

Patients must pay attention to personal hygiene and seek medical attention immediately if symptoms such as frequent urination, painful urination, pruritus vulvae, or redness and swelling occur.

Warnings for Special Metabolic Risks

Diabetic Ketoacidosis (DKA): DKA may occur even when blood glucose levels are normal. If a patient experiences symptoms such as nausea, vomiting, abdominal pain, difficulty breathing, or altered consciousness, urgent testing of blood/urine ketone bodies is required.

Acute Pancreatitis: Persistent severe abdominal pain accompanied by vomiting requires investigation for acute pancreatitis.

Lower Limb Amputation Risk: International clinical trials suggest that canagliflozin may increase this risk; close attention should be paid to foot circulation.

Monitoring During Administration of Teneligliptin Hydrobromide/Canagliflozin Combination Tablets (Canalia)

Blood Glucose Monitoring and Efficacy Evaluation

Fasting and postprandial blood glucose should be tested regularly. If the therapeutic effect remains insufficient after 3 consecutive months of medication use, the treatment plan needs to be adjusted.

It is recommended to establish individualized blood glucose control targets to avoid over-treatment.

Dynamic Tracking of Renal Function

Mild renal impairment: Monitoring is required at least once every 6 months.

Moderate renal impairment: Monitoring is required once every 3 months.

Severe renal impairment or dialysis patients: Use is contraindicated.

Testing of Electrolytes and Metabolic Indicators

Blood ketone bodies, uric acid, and calcium-phosphorus metabolism indicators should be checked every 3–6 months.

For patients co-administered with diuretics or at risk of malnutrition, the frequency of monitoring should be increased.