Pharmacy Times

A Therapeutic Option for the Management of Type 2 Diabetes

This article was sponsored by Janssen Pharmaceuticals, Inc.

Type 2 diabetes mellitus (T2DM), which accounts for 90% to 95% of all cases of diabetes in adults, is a disorder that is characterized by hyperglycemia.1,2
 In addition to insulin resistance and beta cell dysfunction, perturbations in the brain, adipose tissue, and kidneys contribute to the hyperglycemia characteristic of T2DM.3 The kidney plays a key role in glucose homeostasis by regulating the reabsorption of glucose following plasma filtration.4 Sodium-glucose co-transporters (SGLTs: SGLT1 and SGLT2) are responsible for glucose reabsorption in the kidney.5

To inform pharmacists about an option for the management of T2DM with a novel mechanism of action, Pharmacy Times has made available an Information for the Pharmacist article that highlights INVOKANATM (canagliflozin), an SGLT2 inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. INVOKANATM is not recommended in patients with [per Indication] type 1 diabetes or diabetic ketoacidosis.6






These outcomes occurred with drug exposure during periods of animal development that correspond to the late second and third trimester of human development. During pregnancy, consider appropriate alternative therapies, especially during the second and third trimesters. INVOKANA™ should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. 
The efficacy and safety of INVOKANA™ have not been established in patients with severe renal impairment (eGFR < 30 mL/min/ 1.73 m2), with end-stage renal disease (ESRD), or receiving dialysis. INVOKANA™ is not expected to be effective in these patient populations. 


In the event of an overdose, contact the Poison Control Center. It is also reasonable to employ the usual supportive measures, eg, remove unabsorbed material from the gastrointestinal tract, employ clinical monitoring, and institute supportive treatment as dictated by the patient’s clinical status. Canagliflozin was negligibly removed during a 4-hour hemodialysis session. Canagliflozin is not expected to be dialyzable by peritoneal dialysis.


Please see full Prescribing Information and Medication Guide.


  1. Centers for Disease Control and Prevention. National diabetes fact sheet, 2011. . Accessed May 3, 2013.
  2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(suppl 1):S67-S74.
  3. DeFronzo RA. Banting lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795.
  4. Neumiller JJ, White JR Jr, Campbell RK. Sodium-glucose co-transport inhibitors: progress and therapeutic potential in type 2 diabetes mellitus. Drugs. 2010;70(4):377-385.
  5. Jabbour SA, Goldstein BJ. Sodium glucose co-transporter 2 inhibitors: blocking renal tubular reabsorption of glucose to improve glycaemic control in patients with diabetes. Int J Clin Pract. 2008;62(8):1279-1284.
  6. INVOKANA™ [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; March 2013.

Canagliflozin is licensed from Mitsubishi Tanabe Pharma Corporation.