canagliflozin
Invokana (canagliflozin) is an SGLT2 inhibitor from Janssen. It makes the kidneys excrete extra glucose, lowering blood sugar in type 2 diabetes, and it also reduces major cardiovascular events and diabetic kidney disease progression in at-risk adults.
This page is based on FDA prescribing information and the EMA medicine record for canagliflozin, cross-checked with MedlinePlus and the National Cancer Institute dictionary; the mechanism is explained in plain language, and analogies are used only where they stay accurate.
How it works
Explains what the medicine does in the body, not dosing, side effects, or safety.
An analogy
The kidney is a recycling plant that normally salvages every gram of sugar from the fluid it filters and sends it back into the blood. Canagliflozin switches off the main conveyor belt, SGLT2, so when sugar levels run high the excess simply rides out with the urine instead of piling up in circulation.
In simple terms
The kidneys filter blood continuously and normally reclaim all the glucose so none is lost in urine. Canagliflozin blocks SGLT2, the transporter responsible for most of that reclamation. Glucose then passes into the urine and leaves the body, which lowers blood sugar without stimulating insulin. The same kidney effect also changes salt and fluid handling, which helps explain the cardiovascular and kidney benefits seen in outcome trials.
In depth
Canagliflozin selectively and reversibly inhibits SGLT2 in the S1 segment of the proximal tubule, reducing renal glucose reabsorption and producing glycosuria independent of insulin secretion or action. The resulting osmotic diuresis and natriuresis lower preload and blood pressure, and shifts in substrate use may improve cardiac energetics. These mechanisms underpin glycaemic control in type 2 diabetes and the reduction in major adverse cardiovascular events and diabetic nephropathy progression demonstrated in outcome trials.
See it in motion
A schematic animation of the mechanism — simplified for clarity, not drawn to scale.
How canagliflozin blocks SGLT2 in the proximal tubule
- Canagliflozin switches off the main conveyor belt, SGLT2, so when sugar levels run high the excess simply rides out with the urine instead of piling up in circulation.
- Canagliflozin selectively and reversibly inhibits SGLT2 in the S1 segment of the proximal tubule, reducing renal glucose reabsorption and producing glycosuria independent of insulin secretion or action.
- Canagliflozin blocks SGLT2, the transporter responsible for most of that reclamation.
- These mechanisms underpin glycaemic control in type 2 diabetes and the reduction in major adverse cardiovascular events and diabetic nephropathy progression demonstrated in outcome trials.
Target: Sodium-glucose co-transporter 2 (SGLT2)
A transporter in the kidney that reclaims almost all filtered glucose back into the blood; blocking it lets surplus glucose leave the body in the urine.
Approved uses
Approved uses differ by country and change over time. Always follow your local prescribing information.
Approved uses in United States
FDA- As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus
- To reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease
- To reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria
Approved uses in European Union
EMA- Treatment of adults and children aged 10 years and older with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise, as monotherapy when metformin is considered inappropriate due to intolerance or contraindications, and in addition to other medicinal products for the treatment of diabetes
Official sources
The statements on this page trace back to these records.
- U.S. Food and Drug Administration: canagliflozin prescribing information
U.S. Food and Drug Administration
- Invokana (canagliflozin) — Summary of product characteristics and package leaflet, English version
European Medicines Agency
- MedlinePlus: canagliflozin
MedlinePlus, U.S. National Library of Medicine
- National Cancer Institute: canagliflozin
National Cancer Institute
This page explains how the medicine works — it isn’t the patient leaflet. For anything that applies to you, read the leaflet that came with your medicine or ask your pharmacist.
MedUnfold provides educational content and is not medical advice. Always follow your local prescribing information and healthcare professional.