Canagliflozin - metformin is a combination of two medications that reduce blood sugar. Both canagliflozin and metformin belong to the class of medications called oral hypoglycemics.

This medication is used by adults with type 2 diabetes who are already taking canagliflozin and metformin as separate tablets and have good glucose control. It may also be used along with insulin or other oral hypoglycemic medications if blood glucose hasn't been well controlled on metformin plus the other medication.

Canagliflozin - metformin is intended to be used as part of an overall diabetes management plan that includes diet and exercise.

Canagliflozin works by increasing the amount of glucose being removed from the body by the kidneys, which decreases the amount of sugar in the blood. Metformin works by reducing the amount of glucose made by the liver and by making it easier for glucose to enter into the tissues of the body.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose for canagliflozin - metformin is one tablet taken by mouth twice a day, with meals. You will start at the dose closest to the dose of canagliflozin and metformin that you are currently taking. Your doctor may adjust the dose up or down, depending on how effective it is and how well it is tolerated. The maximum total daily dose is 300 mg of canagliflozin and 2000 mg of metformin.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. Tablets should be swallowed whole.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

50 mg/500 mg
Each capsule-shaped, white, film-coated tablet with "CM" on one side and "155" on the other contains 50 mg of canagliflozin as canagliflozin hemihydrate and 500 mg of metformin hydrochloride. Nonmedicinal ingredients: croscarmellose sodium, hypromellose (2910), magnesium stearate, and microcrystalline cellulose; film coating: macrogol (polyethylene glycol), polyvinyl alcohol (partially hydrolyzed), talc, and titanium dioxide.

50 mg/ 1,000 mg
Each capsule-shaped, beige, film-coated tablet with "CM" on one side and "551" on the other, contains 50 mg of canagliflozin as canagliflozin hemihydrate and 1,000 mg of metformin hydrochloride. Nonmedicinal ingredients: croscarmellose sodium, hypromellose (2910), magnesium stearate, and microcrystalline cellulose; film coating: macrogol (polyethylene glycol), polyvinyl alcohol (partially hydrolyzed), talc, iron oxide red, iron oxide yellow, and titanium dioxide.

150 mg/500 mg
Each capsule-shaped, yellow, film-coated tablet with "CM" on one side and "215" on the other, contains 150 mg of canagliflozin as canagliflozin hemihydrate and 500 mg of metformin hydrochloride. Nonmedicinal ingredients: croscarmellose sodium, hypromellose (2910), magnesium stearate, and microcrystalline cellulose; film coating: macrogol (polyethylene glycol) polyvinyl alcohol (partially hydrolyzed), talc, iron oxide red, iron oxide yellow, and titanium dioxide.

150 mg/1,000 mg
Each capsule-shaped, purple, film-coated tablet with "CM" on one side and "611" on the other, contains 150 mg of canagliflozin as canagliflozin hemihydrate and 1,000 mg of metformin hydrochloride. Nonmedicinal ingredients: croscarmellose sodium, hypromellose (2910), magnesium stearate, and microcrystalline cellulose; film coating: macrogol (polyethylene glycol), polyvinyl alcohol (partially hydrolyzed), talc, iron oxide black, iron oxide red, and titanium dioxide.

Do not take this medication if you:

• are allergic to canagliflozin, metformin, or any ingredients of the medication
• have uncontrolled type 2 diabetes mellitus
• have type 1 diabetes mellitus
• have a history of ketoacidosis or lactic acidosis
• have acute or chronic metabolic acidosis
• have moderately-to-severely decreased kidney function
• consume excessive amounts of alcohol
• have severely decreased liver function
• have an unusually low level of oxygen in the blood
• have severe heart problems or heart failure
• are in a state of physiologic shock
• are experiencing physiological stress (e.g., severe infection, trauma, surgery or recovery after surgery)
• are severely dehydrated
• are or may be pregnant
• are breastfeeding
• have recently been treated with iodinated contrast materials for X-ray or CT scan

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal discomfort
• constipation
• diarrhea
• fatigue
• gas
• headache
• heartburn or indigestion
• loss of appetite
• metallic taste in the mouth
• more frequent urination
• nausea
• rash or hives
• thirst
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• dizziness or fainting when rising from a sitting or lying position
• severe infection spreading from the urinary tract throughout the body (e.g., fever, low body temperature, rapid breathing, chills, rapid heartbeat)
• signs of dehydration (e.g., decreased urine, dry skin, dry and sticky mouth, sleepiness, dizziness, headache, thirst, confusion)
• signs of kidney problems (e.g., any change in amount, frequency, or colour of urine)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• skin ulcer or infection
• symptoms of decreased blood circulation in the legs or feet (e.g. pain with walking, bluish colour, cold skin, poor nail and hair growth)
• symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
• symptoms of a urinary tract or kidney infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain)
• symptoms of vaginal yeast infection (e.g., odour, white or yellowish vaginal discharge, itching)
• yeast infection of the penis (e.g., rash or redness of the penis or foreskin)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• pain, swelling, tenderness in the genital or perineal area, with or without fever, weakness, tiredness
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of diabetic ketoacidosis (DKA) (e.g., difficulty breathing, extreme thirst, vomiting, nausea, loss of appetite, confusion, unusual tiredness)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• symptoms of too much potassium in the body (e.g., muscle fatigue, weakness, difficulty moving, abnormal heart rhythms, nausea)
• signs of lactic acidosis (e.g., nausea, vomiting, increased breathing rate, abdominal pain, unusual tiredness, dizziness, rapid heart rate)
• severely low blood sugar (e.g., disorientation, loss of consciousness, seizure)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Alcohol consumption: If you are taking metformin, you should avoid excessive alcohol intake.

Amputation: There may be an increased risk of lower leg or toe amputations for people taking this medication, especially if you are at high risk for heart disease. Good foot care is very important for people with diabetes. Contact your doctor as soon as possible if you notice symptoms of pain or any sores, ulcers, or infections in your leg or foot.

Dehydration: Canagliflozin – metformin may cause a decrease in the amount of fluid in your body. This dehydration has effects throughout the body. Dehydration can cause decreased kidney function, which in turn, reduces the effectiveness of this medication. It can cause decreased blood pressure, which may cause dizziness or fainting. Severely decreased blood pressure also contributes to heart problems. Certain other medications, such as diuretics (water pills) can cause dehydration. If you experience symptoms of dehydration, such as thirst, decreased urine or tear production, dizziness, or headaches, contact your doctor.

Diabetic ketoacidosis (DKA): Canagliflozin has been associated with DKA. This is a potentially life-threatening condition which occurs when there isn't enough insulin in the blood to use the glucose in the bloodstream. When this happens, the body starts to burn ketones for fuel and can make the blood acidic. This condition is more likely to develop if you are following a very low carbohydrate diet, are dehydrated, or have consumed a large amount of alcohol. Symptoms of DKA include difficulty breathing, nausea, vomiting, abdominal pain, confusion, loss of appetite, excessive thirst, and unusual fatigue or sleepiness. If you experience these symptoms, get immediate medical help.

Blood pressure: Some people taking canagliflozin may experience decreases in blood pressure. This occurs because the medication causes an increased amount of fluid to be removed from the body through the kidneys along with the glucose. These blood pressure drops could lead to dizziness, lightheadedness, and falls. This may occur when you shift your body position, such as rising from a sitting or lying position. If you experience this problem, try getting up more slowly. If it persists or if you faint, contact your doctor. Seniors and other individuals who are at risk of experiencing low blood pressure (e.g., dehydration, taking medications for high blood pressure) should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Cholesterol: Canagliflozin may increase cholesterol levels. If you have increased cholesterol, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness/reduced alertness: Canagliflozin - metformin may cause dizziness or lightheadedness, which may in turn affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Fractures: There is a very small increase in the risk of bone fractures for people taking canagliflozin – metformin. If you are at risk of osteoporosis or are taking medications that may decrease the strength of your bones, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Glucose control: When canagliflozin is taken along with other medications for diabetes, glucose levels may drop too far, causing confusion, cold sweats, cool and pale skin, headache, fast heartbeat, or weakness. If you are using insulin, your doctor may suggest decreasing the dose of the insulin when you first start taking canagliflozin - metformin. If you take other medications for diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: The effectiveness of canagliflozin depends on kidney function because it increases the amount of glucose eliminated through the kidneys. Over time, this medication may cause kidney problems. If you experience signs of kidney problems, such as puffy hands, face or feet, high blood pressure, unusual muscle cramping, or darkened urine, this medication may be affecting how well your kidneys are working. If you notice any of these symptoms, contact your doctor as soon as possible.

Decreased kidney function or kidney disease can cause metformin to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Lactic acidosis: Lactic acidosis is a rare but serious problem that occurs due to metformin accumulation (i.e., the body doesn't get rid of it fast enough) during treatment. If you have severe kidney disease you are at higher risk of developing lactic acidosis. Since alcohol may increase the risk of lactic acidosis, do not drink a lot of alcohol over the short- or long-term while taking this medication. When it does occur, it is fatal in 50% of cases. If you experience symptoms of lactic acidosis (e.g., weakness, tiredness, drowsiness, unusual muscle pain, trouble breathing, stomach pain with nausea, vomiting or diarrhea, feeling cold, dizziness, lightheadedness, or slow or irregular heartbeat), stop taking this medication and get immediate medical attention.

Liver function: Decreased liver function has been linked to lactic acidosis. This medication is not recommended for people with severely reduced liver function. If you have moderately reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Potassium levels: Canagliflozin can cause increased blood levels of potassium. This is more likely to occur if you have decreased kidney function or are taking medications that prevent potassium from being removed from the body such as some water pills and certain blood pressure medications. If you experience unexplained nausea, fatigue, muscle weakness, or tingling sensations, contact your doctor.

Reduced response: Over a period of time, you may become progressively less responsive to a particular treatment for diabetes because your diabetes has worsened. If canagliflozin - metformin fails to lower blood sugar to target levels, talk to your doctor. Your doctor may want to stop metformin or recommend another medication.

Surgery: This medication should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on this medication once you are eating and drinking, and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.

Urinary tract infection: This medication increases the risk of developing urinary tract infections. If you experience symptoms of a urinary tract infection, such as increased need to urinate, burning sensation when urinating, cloudy urine, strong-smelling urine, or pelvic pain, contact your doctor.

Vitamin B12 levels: Metformin may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking this medication.

Yeast infections: There is an increased risk of developing genital yeast infections when taking canagliflozin as a result of increased glucose in the urine. This is more likely to occur for uncircumcised men and for people who have a history of yeast infections.

Pregnancy: This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if canagliflozin passes into breast milk. Metformin passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Breast-feeding is not recommended when you are taking this medication.

Children: The safety and effectiveness of this medication have not been established for children less than 18 years of age.

Seniors: Seniors are more likely to experience side effects with this medication and may require lower doses.

There may be an interaction between canagliflozin - metformin and any of the following:

• acetazolamide
• acetylsalicylic acid (ASA)
• alcohol
• aliskiren
• androgens (e.g., testosterone)
• angiotensin converting enzyme inhibitors (ACEIs; captopril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• atypical antipsychotics (e.g., cariprazine, clozapine, olanzapine, quetiapine, risperidone)
• beta-blockers (e.g., atenolol, carvedilol, labetalol, metoprolol, sotalol)
• bictegravir
• bismuth subsalicylate
• bortezomib
• buserelin
• cephalexin
• cimetidine
• corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• danazol
• other diabetes medications (e.g., glyburide, insulin, rosiglitazone)
• diazoxide
• digoxin
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• dolutegravir
• epinephrine
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• everolimus
• glucagon
• glycopyrrolate
• goserelin
• hepatitis C antivirals (e.g., elbasvir and grazoprevir, glecaprevir and pibrentasvir, sofosbuvir, velpatasvir, voxilaprevir)
• HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)
• hydroxychloroquine
• iodinated contrast material
• lamotrigine
• leuprolide
• linezolid
• lithium
• mifepristone
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• niacin
• nirmatrelvir and ritonavir
• non-steroidal anti-inflammatory drugs (NSAIDs; e.g., celecoxib, diclofenac, ibuprofen, ketorolac, naproxen)
• ondansetron
• patiromer
• pegvisomant
• phenobarbital
• phenytoin
• primidone
• progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
• protein kinase inhibitors (e.g., ceritinib, dabrafenib, lorlatinib, nilotinib, sunitinib)
• quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, norfloxacin)
• ranolazine
• rifampin
• rosuvastatin
• St. John's wort
• somatostatin analogues (e.g., lanreotide, octreotide, pasireotide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline, vortioxetine)
• sirolimus
• sulfamethoxazole
• tacrolimus
• terbutaline
• topiramate
• tramadol
• trimethoprim
• triptorelin
• verapamil
• vilazodone
• vorinostat
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.