Which of the following are drug interactions with canagliflozin?

• A. Diuretics, rifampin, phenytoin, phenobarbital
• B. ACE inhibitors and ARBs
• C. Metformin and glyburide
• D. Acetaminophen and ibuprofen

Answer: (A)

Canagliflozin is an SGLT2 inhibitor, so when thinking about drug interactions the focus is on effects that change its exposure or increase risks from diuresis. Diuretics can heighten the risk of volume depletion and low blood pressure when used with canagliflozin because both promote fluid loss. In addition, drugs that induce hepatic enzymes or transporters—like rifampin, phenytoin, and phenobarbital—can increase the metabolism of canagliflozin, lowering its levels and potentially reducing its glucose-lowering effect. That combination—diuretics plus enzyme inducers—best captures the known interactions with canagliflozin.

The other options don’t reflect meaningful pharmacokinetic interactions with canagliflozin. ACE inhibitors and ARBs are commonly used with canagliflozin and mainly require monitoring for blood pressure and kidney function rather than a direct drug–drug interaction. Metformin and glyburide can be used together with canagliflozin without a specific interaction that changes its exposure. Acetaminophen and ibuprofen do not affect canagliflozin’s pharmacokinetics.