If a patient is taking Invokana and has elevated creatinine levels, which medication should be discontinued?

Invokana, also known as canagliflozin, is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used in the management of type 2 diabetes. It is vital to monitor kidney function in patients taking this medication, as SGLT2 inhibitors can impact renal excretion of glucose and may lead to dehydration and impaired kidney function.

When a patient has elevated creatinine levels, it indicates compromised kidney function. In this context, metformin is often the medication that should be considered for discontinuation. The use of metformin in patients with renal impairment is concerning because it is contraindicated in patients with significant renal dysfunction, as it can increase the risk of lactic acidosis—a rare but serious condition. The guidelines typically recommend that metformin be withheld if the estimated glomerular filtration rate (eGFR) falls below 30 mL/min, and caution is advised if eGFR is between 30 and 45 mL/min.

Other medications listed, such as insulin, glipizide, and levothyroxine, do not have the same strict contraindications associated with elevated creatinine levels. Insulin and glipizide are both oral hypoglycemic agents that can still be