AI Summary Canagliflozin (Invokana) lowers blood sugar through the kidneys, which clear extra glucose from the body in urine instead of the bloodstream.
Source: Liver Therapies Patient Guide, July 15, 2026
Medically reviewed.
Canagliflozin (Invokana) is a prescription sodium-glucose cotransporter 2 (SGLT2) inhibitor approved to improve glycemic control in adults with type 2 diabetes. It is also approved 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 and diabetic nephropathy with albuminuria. Because obesity, insulin resistance, and type 2 diabetes are closely linked to MASLD and MASH, some healthcare providers may consider canagliflozin for eligible patients to help manage these underlying metabolic risk factors, even though it is not FDA-approved specifically for liver disease. Treatment decisions should always be individualized and guided by a healthcare professional.
This page covers canagliflozin's role in metabolic and MASLD/MASH management — how it works, who may be eligible, benefits, side effects, and monitoring. You can also connect with a liver specialist near you for personalized guidance on whether canagliflozin fits your care plan.
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ABOUT CANAGLIFLOZIN TREATMENT
Canagliflozin is a prescription medicine sold under the brand name Invokana. It belongs to a class of medications called sodium-glucose cotransporter 2 (SGLT2) inhibitors, which work in the kidneys rather than the liver or pancreas.
Canagliflozin is approved to improve glycemic control in adults with type 2 diabetes. It is also approved 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 and diabetic nephropathy with albuminuria. Because obesity, insulin resistance, and elevated blood sugar are closely linked to MASLD and MASH, some healthcare providers may consider canagliflozin to address these underlying metabolic risk factors, even though it is not FDA-approved specifically for liver disease.
It is typically used as part of a broader, personalised treatment plan that may include dietary changes, physical activity, and regular monitoring by your healthcare provider, such as Liver Function Tests (LFTs) or imaging.
WHO CANAGLIFLOZIN MAY BE SUITABLE FOR
Eligibility for canagliflozin depends on the medication's approved uses, your diagnosis, and your individual health needs. Canagliflozin is approved for adults with type 2 diabetes who need additional blood sugar control, and for those with type 2 diabetes and diabetic nephropathy with albuminuria who need to reduce their risk of kidney or cardiovascular complications. It may be considered for people who meet these criteria and who also have MASLD or MASH linked to metabolic risk factors such as obesity, insulin resistance, or elevated blood sugar.
Because kidney function affects how canagliflozin works, your healthcare provider will review your renal function along with your medical history, current health status, liver condition, and other medications before prescribing it.
Because every patient's health profile is different, there is no one-size-fits-all answer to who should take canagliflozin. Treatment decisions are individualized and should be made by a qualified healthcare professional after a full assessment of your liver condition, kidney function, metabolic health, and treatment goals.
ELIGIBILITY OVERVIEW
Canagliflozin may be considered for adults with the following conditions, risk factors, or treatment goals:
Before recommending canagliflozin, healthcare providers evaluate several factors to determine whether it is an appropriate option, including:
HOW CANAGLIFLOZIN CAN HELP YOUR LIVER
Canagliflozin inhibits sodium-glucose cotransporter 2 (SGLT2) in the kidney, which reduces how much glucose the kidneys reabsorb and increases the amount removed through urine. This lowers blood glucose levels in adults with type 2 diabetes and reduces the risk of certain renal and cardiovascular outcomes in eligible patients.
These actions target metabolic drivers linked to MASLD and MASH: elevated blood sugar, excess body weight, and the metabolic strain that insulin resistance places on the liver and kidneys. As blood sugar control improves and modest weight loss occurs, some of the metabolic pressure that contributes to fat buildup in the liver may ease.
For patients with MASLD or MASH and related metabolic risk factors, these changes can support broader treatment goals such as better blood sugar control and reduced cardiovascular or kidney risk. Canagliflozin is not used on its own — providers pair it with dietary changes, physical activity, and regular monitoring, such as Liver Function Tests (LFTs), to support these outcomes.
LIVER BENEFITS
MASLD and MASH are often linked to obesity, type 2 diabetes, and other metabolic conditions. When blood sugar stays high, the body has to work harder to manage it, and that adds metabolic strain. Canagliflozin lowers blood glucose by acting on the kidneys, which remove extra glucose through urine. It does not act directly on the liver. By helping bring blood sugar down in adults with type 2 diabetes, it may ease part of the metabolic pressure that is linked to liver disease.
Excess body weight is another factor that is closely tied to MASLD and MASH. Canagliflozin may contribute to modest weight loss and improved metabolic health. This is a possible effect, not a promise, and it varies from person to person. Weight changes from the medication work best alongside the balanced diet, regular physical activity, and weight management that your healthcare provider recommends.
Canagliflozin works in the kidneys, so kidney function shapes whether it is a good fit and how it is used. Your healthcare provider reviews your kidney function before prescribing it. Kidney function, blood glucose, hydration status, and treatment response are then checked regularly during treatment. When canagliflozin is used for MASLD or MASH management, your provider may also follow liver health measures, such as Liver Function Tests, so that your liver and kidneys are reviewed together over time.
Canagliflozin is also approved to reduce the risk of certain heart and kidney outcomes in eligible adults with type 2 diabetes and diabetic nephropathy with albuminuria. For people who live with both type 2 diabetes and a metabolic liver condition, this can matter when a provider chooses a therapy. Your provider considers your whole health picture, including your liver, kidneys, heart, and blood sugar, before recommending it.
Canagliflozin is not a direct liver treatment. It targets blood sugar, weight, and kidney and heart risk, which overlap with the drivers of MASLD or MASH in people who also have diabetes. It should only be started and monitored under the guidance of a qualified healthcare professional.
TREATMENT PROCESS
Invokana is supplied as an oral tablet. Take it exactly as prescribed by your healthcare provider.
The typical starting dose is 100 mg once daily. In patients with adequate renal function and tolerability, the dose may be increased to 300 mg once daily for additional glycemic control. Your healthcare provider determines the right dose for you.
Canagliflozin is a once-daily oral tablet — it is not an injection or infusion. Take it before the first meal of the day, and maintain adequate hydration throughout treatment.
Canagliflozin is generally used as a long-term therapy for type 2 diabetes and for cardiovascular and kidney risk reduction in eligible patients. Treatment is continued as long as clinical benefit is maintained and the medication is well tolerated.
Store canagliflozin tablets at room temperature, away from moisture and heat.
Your healthcare provider will regularly monitor blood glucose levels, kidney function, and hydration status. For people using canagliflozin to support MASLD or MASH management, providers may also monitor liver health measures, such as Liver Function Tests (LFTs), alongside routine follow-up. Report any side effects or unusual symptoms to your healthcare provider.
BENEFITS AND SAFETY
Canagliflozin (Invokana) may support people with MASLD and MASH who also have type 2 diabetes by targeting metabolic risk factors — elevated blood sugar, excess weight, and cardiovascular or kidney risk — that overlap with liver disease drivers. By lowering blood glucose and supporting modest weight loss, it may contribute to better metabolic health, though it is not a direct liver treatment. The extent of any benefit varies from person to person, depending on liver condition, kidney function, overall metabolic health, and how the body responds to therapy. Canagliflozin is not a stand-alone liver treatment — it works best as part of a broader, personalised care plan that combines the medication with lifestyle changes, such as a liver-healthy diet and regular physical activity, along with ongoing monitoring like Liver Function Tests (LFTs) or imaging.
As with any medication, canagliflozin may cause side effects, ranging from urinary and genital infections to dehydration and dizziness. Your healthcare provider will assess whether canagliflozin is a suitable option for you and will monitor your treatment response throughout therapy, adjusting the dose or overall care plan as needed to balance potential benefits against any risks.
BENEFITS
Canagliflozin helps lower blood glucose levels and improve diabetes management in adults with type 2 diabetes. It does this by blocking SGLT2 in the kidney, so the kidneys reabsorb less glucose and more leaves the body in urine. Providers often consider it when a person needs additional blood sugar control.
Canagliflozin may contribute to modest weight loss and improved metabolic health. The effect is usually small and differs from person to person. It tends to work best when paired with healthy eating, regular activity, and the weight management goals you set with your provider.
Canagliflozin may reduce the risk of certain heart-related complications in eligible patients. In adults with type 2 diabetes and diabetic nephropathy with albuminuria, it is approved to reduce the risk of cardiovascular death and hospitalization for heart failure. Your provider decides whether you are eligible.
Canagliflozin may help protect kidney function and reduce progression of kidney disease. In adults with type 2 diabetes and diabetic nephropathy with albuminuria, it is approved to reduce the risk of end-stage kidney disease and doubling of serum creatinine. Regular kidney function checks help your provider follow how well it is working for you.
Canagliflozin is a once-daily tablet, so it does not require injections or infusions. You take it before the first meal of the day, exactly as prescribed. Because it increases urination, staying well hydrated is an important part of taking it.
These effects are often more noticeable when starting treatment or adjusting the dose and may improve over time. Your healthcare provider will discuss the potential benefits and risks before treatment, and maintaining good hydration is especially important due to increased urination.
SUPPORTING YOUR RESULTS
Canagliflozin works best when combined with a balanced diet, regular physical activity, weight management, and other lifestyle modifications recommended by your healthcare provider. Maintaining good hydration is especially important due to increased urination.
These habits can support how your body responds to treatment and may help improve outcomes over time.
Areas that may support treatment:
COMMON QUESTIONS
No, canagliflozin is not a direct treatment for MASLD or MASH. It is an SGLT2 inhibitor approved to improve blood sugar control in type 2 diabetes and to reduce cardiovascular and kidney risk in eligible patients. Because obesity, insulin resistance, and elevated blood sugar are closely linked to liver disease, some healthcare providers may consider canagliflozin to help manage these underlying risk factors, but it is not FDA-approved specifically for liver disease.
Canagliflozin may be considered for adults with type 2 diabetes who need additional blood sugar control, especially those with diabetic nephropathy and albuminuria, or those with MASLD or MASH linked to metabolic risk factors such as obesity or insulin resistance. Eligibility depends on your medical history, kidney function, and liver condition, and should be determined by a qualified healthcare professional.
The typical starting dose is 100 mg once daily, taken as an oral tablet before the first meal of the day. Depending on kidney function and tolerability, your healthcare provider may increase the dose to 300 mg once daily for additional blood sugar control.
The most common side effects include urinary tract infections, genital yeast infections, increased urination, dehydration, and dizziness. Maintaining good hydration is especially important. Report any side effects or unusual symptoms to your healthcare provider, who can adjust your treatment plan if needed.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
