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.
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.
Dizziness /reduced alertness: Canagliflozin - metformin may cause dizziness or light-headedness, 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.
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 (very rarely), 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, light-headedness, 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 worsens. 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.
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 or vaginal 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 a breast-feeding mother and are 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.