[8] Canagliflozin is an anti-diabetic medication used to improve blood sugar control in people with type 2 diabetes.

[14] SGLT2 inhibitors, including canagliflozin, reduce the likelihood of hospitalization for congestive heart failure or progression of renal disease in persons with diabetes mellitus type 2 and reduce the likelihood of stroke and heart attack in persons with diabetes mellitus type 2 who have known atherosclerotic vascular disease.

Nonetheless, a United States Food and Drug Administration (FDA) advisory committee expressed concern regarding the cardiovascular safety of canagliflozin.

The FDA is continuing to investigate the issue, and cautions that patients should not stop taking canagliflozin without first talking to their doctor.

[23] On 4 December 2015, the FDA issued another safety communication for SGLT2 inhibitors, indicating that it would require new warnings to be added to the canagliflozin label about elevated blood acid levels and urinary tract infections.

[24] In June 2016, the FDA strengthened the warning about the risk of acute kidney injury for the type 2 diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR).

[25] A 29 June 2016, report on the ongoing cardiovascular outcomes trial for canagliflozin (CANVAS) revealed interim findings of new safety concerns including heightened risk of bone fracture that was found to increase with the duration of treatment.

[26] In May 2016, the FDA announced they were going to investigate a safety issue related to clinical trials that found an increase in leg and foot amputations, mostly affecting the toes, in people treated with the diabetes medicine canagliflozin (Invokana, Invokamet).

[28] The FDA began requiring a boxed warning to be added to the canagliflozin drug labels to describe this risk.

[8] To lessen the risk of developing ketoacidosis (a serious condition in which the body produces high levels of blood acids called ketones) after surgery, the FDA approved changes to the prescribing information for SGLT2 inhibitor diabetes medicines to recommend they be stopped temporarily before scheduled surgery.

[32] Dosing adjustment is also required for concomitant therapy with UDP-glucuronosyl transferase (UGT) inducers such as rifampin, phenytoin, or phenobarbital, ritonavir.

[3] Canagliflozin is an inhibitor of subtype 2 sodium-glucose transport proteins (SGLT2), which is responsible for at least 90% of renal glucose reabsorption (the remaining 10% is done by SGLT1 inhibition[33][34]).

[36] When taken by mouth, canagliflozin reaches highest blood plasma concentrations after one to two hours and has an absolute bioavailability of 65%, independently of food intake.