SUMMARY  

• When ritonavir, an inducer of UDP-glucuronosyltransferase (UGTs), is co-administered with canagliflozin, it is recommended to increase the canagliflozin dose.¹
• Consider monitoring for hyperglycemia, new onset diabetes mellitus, or an exacerbation of diabetes mellitus in patients treated with ritonavir.²

PRODUCT LABELING

Drug Interactions

Co-administration of INVOKANA with ritonavir, an UGT enzyme inducer, decreases canagliflozin exposure, which may reduce the effectiveness of INVOKANA.¹

For patients with estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m² or greater, if an inducer of UGTs (e.g., rifampin, phenytoin, phenobarbital, ritonavir) is administered with INVOKANA, increase the dosage to 200 mg (taken as two 100-mg tablets) once daily in patients currently tolerating INVOKANA 100 mg.¹ The total daily dosage may be increased to 300 mg once daily in patients currently tolerating INVOKANA 200 mg and who require additional glycemic control.¹

For patients with eGFR <60 mL/min/1.73 m², if an inducer of UGTs (e.g., rifampin, phenytoin, phenobarbital, ritonavir) is administered with INVOKANA, increase the dosage to 200 mg (taken as two 100-mg tablets) once daily in patients currently tolerating INVOKANA 100 mg.¹ Consider adding another antihyperglycemic agent in patients who require additional glycemic control.¹

Warnings and Precautions

New onset diabetes mellitus, exacerbation of pre-existing diabetes mellitus, and hyperglycemia have been reported during postmarketing surveillance in human immunodeficiency virus-infected patients receiving protease inhibitor therapy.² Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, diabetic ketoacidosis has occurred. In those patients who discontinued protease inhibitor therapy, hyperglycemia persisted in some cases. Because these events have been reported voluntarily during clinical practice, estimates of frequency cannot be made and a causal relationship between protease inhibitor therapy and these events has not been established. Consider monitoring for hyperglycemia, new onset diabetes mellitus, or an exacerbation of diabetes mellitus in patients treated with ritonavir.

Literature Search

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, and DERWENT^® Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 16 February 2024.