Place of sodium-glucose co-transporter type 2 inhibitors for treatment of type 2 diabetes

Table 1 Differences between canagliflozin and dapagliflozin

	Canagliflozin (Invokana)[4]	Dapagliflozin (Forxiga)[5]
Approved doses	Starting dose 100 mg tablet qd, taken before breakfast. If tolerated, dose can be increased to 300 mg tablet qd	Starting dose 5 mg tablet qd taken in the morning with or without food. If tolerated, dose can be increased to 10 mg tablet qd
Use in CKD	Contraindicated with eGFR < 45 mL/min per 1.73 m2. Dose limited to 100 mg/d with eGFR of 45-59 mL/min per 1.73 m2	Not recommended with eGFR < 60 mL/min per 1.73 m2. No dose adjustment is needed with milder CKD
Hepatic impairment (Child-Pugh classification: A: mild, B: moderate, C: severe)	No dosage adjustment is needed with mild or moderate hepatic impairment. Not recommended with severe hepatic impairment	No dosage adjustment is needed with mild or moderate hepatic impairment. Start with smaller dose (5 mg/d) in severe hepatic impairment then the high-dose 10 mg/d if tolerated
Drug interactions	Use higher dose (300 mg/d) with UGT enzyme inducers (e.g., rifampin)	No dose adjustment is needed when used with UGT enzyme inducers
	↑ C max of digoxin by 36%. Use low starting digoxin doses, and monitor serum digoxin levels closely	No interaction with digoxin
Effect on LDL-C levels (mean percentage change vs placebo)	↑ 4.5%-8%	↑ 3.9%
Possible increase in cardiovascular events	A trend toward increase in non fatal stroke and cardiovascular events (see text)	Not observed
Possible increase in cancer	Not observed	Possible increase in bladder cancer (0.17% vs 0.03% with placebo)

eGFR: Estimated glomerular filtration rate; Cmax: Maximum plasma concentration; CKD: Chronic kidney disease.