The coalition’s promise to streamline the addition of medicines to the PBS may have been unnecessary, as seen with canagliflozin’s approval in July, two months ahead of its addition to the Australian Register of Therapeutic Goods.

Canagliflozin (Invokana®) tablets are for adults with Type 2 Diabetes Mellitus when metformin is inappropriate, or to augment other medicines that don’t achieve sufficient glucose control, in conjunction with a healthy diet and exercise regime. It inhibits sodium-glucose co-transporter 2 (SGLT2), and lowers the renal threshold, to reduce the reabsorption of filtered glucose and increase urinary excretion.

This third-line alternative to current therapies is the first-in-class to be recommended for the PBS, hence the authority listing. It may also be in demand, however, for its weight loss properties.

It has comparative efficacy, but more adverse reactions than sitagliptin and is interchangeable with classmate dapagliflozin.

Efficacy is dependent on renal function, and it is contraindicated with severe renal impairment. Canagliflozin may contribute to hyperkalaemia, hypoglycaemia, and intravascular fluid depletion through osmotic diuresis.

The dose of canagliflozin may need adjustment if co-administered with medicines that induce or inhibit UDP-glucuronosyltransferase (UGT) enzymes and transport proteins, but it has little effect on other drugs.

Very common adverse reactions are gastrointestinal (constipation, nausea, thirst), excessive osmotic diuresis, urinary tract infections and genital mycotic infections.

The individualised dose should be taken with the first meal of the day.

Before prescribing please read the full Product Information.

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