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Invokana
Invokana, the brand name for canagliflozin, is an oral medication used to treat type 2 diabetes mellitus. It belongs to the class of drugs known as SGLT2 inhibitors (sodium-glucose co-transporter 2 inhibitors). Invokana works by helping the kidneys remove excess sugar from the bloodstream through urine, lowering blood sugar levels in people with type 2 diabetes. In addition to controlling blood sugar, Invokana may also help reduce the risk of heart disease and kidney disease in patients with type 2 diabetes.
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Frequently Asked Questions
How long does it take for Invokana to start working?
Invokana begins to lower blood sugar levels within hours of taking the first dose, but it may take several weeks to see the full effect on glycemic control.
Can Invokana be used with other diabetes medications?
Yes, Invokana is often prescribed in combination with other diabetes medications like metformin or insulin to better control blood sugar.
Does Invokana cause weight loss?
Some patients may experience mild weight loss while taking Invokana due to its effects on glucose excretion and potential appetite suppression.
Can I drink alcohol while taking Invokana?
It is best to limit alcohol consumption while taking Invokana, as alcohol can increase the risk of dehydration and hypoglycemia.
Is Invokana safe for patients with kidney disease?
Invokana is not recommended for patients with severe kidney disease or those on dialysis. Kidney function should be monitored regularly during treatment, especially in patients with mild to moderate renal impairment.
Comprehensive Drug Guide
How Does Invokana Work?
Invokana works by inhibiting the SGLT2 protein in the kidneys, which is responsible for reabsorbing glucose back into the blood. By blocking this process, Invokana increases the amount of glucose excreted in the urine, effectively lowering blood sugar levels. Additionally, it helps to reduce blood pressure and may promote weight loss, both of which are beneficial for patients with type 2 diabetes.
Common Dosages
- 100 mg tablets
- 300 mg tablets
Typical Dosing
- For glycemic control in type 2 diabetes: The usual starting dose is 100 mg once daily before the first meal of the day. The dose may be increased to 300 mg once daily for patients who need additional blood sugar control and tolerate the medication well.
- For kidney protection and cardiovascular risk reduction: The dose is typically 100 mg to 300 mg once daily, depending on renal function and clinical need.
Typical Dosing
FDA Approved Indications
- Type 2 diabetes mellitus to improve glycemic control in adults, along with diet and exercise.
- Reducing the risk of cardiovascular events in patients with type 2 diabetes and established cardiovascular disease.
- Reducing the risk of end-stage kidney disease in patients with type 2 diabetes and diabetic nephropathy.
Who Shouldn't Take Invokana?
- Severe renal impairment, end-stage renal disease (ESRD), or patients on dialysis.
- A history of serious hypersensitivity to canagliflozin or any of its components.
- Patients with diabetic ketoacidosis should avoid this medication.
Advice From The Pharmacist
- Invokana should be taken once daily before the first meal of the day.
- Stay well-hydrated while taking Invokana, as it can increase the risk of dehydration and low blood pressure.
- Monitor your blood sugar regularly and watch for signs of urinary tract infections or yeast infections, as these are common side effects.
- Contact your doctor if you experience symptoms of ketoacidosis (nausea, vomiting, abdominal pain, or confusion).
- Regular blood tests may be required to monitor kidney function and electrolyte levels.
Side Effects of Invokana
Common Side Effects
- Increased urination
- Genital yeast infections (in both men and women)
- Urinary tract infections
- Thirst
- Mild dehydration
Uncommon/Severe Side Effects
- Ketoacidosis, a potentially life-threatening condition that can occur even with normal blood sugar levels.
- Kidney problems, especially in patients with pre-existing renal impairment.
- Lower limb amputations: Invokana has been associated with an increased risk of amputations, especially in patients with a history of foot problems or poor circulation.
Risks and Warnings of Invokana
- Amputation risk: Invokana carries a boxed warning for an increased risk of lower limb amputations, particularly in patients with pre-existing risk factors like foot ulcers or peripheral vascular disease. Patients should be closely monitored for signs of foot problems.
- Ketoacidosis: Patients taking Invokana may develop ketoacidosis, which can be dangerous even when blood sugar levels are not significantly elevated. Patients should be alert to symptoms like nausea, vomiting, and difficulty breathing.
- Dehydration and low blood pressure: Invokana may cause dehydration, which can lead to dizziness or fainting, especially in elderly patients or those taking diuretics.
Interactions with Invokana
Common Drug Interactions
- Diuretics: Taking Invokana with diuretics may increase the risk of dehydration and low blood pressure.
- Insulin or insulin secretagogues: Combining Invokana with insulin or sulfonylureas may increase the risk of hypoglycemia (low blood sugar).
- ACE inhibitors or ARBs: These medications, which are used to treat high blood pressure, may interact with Invokana and increase the risk of kidney problems.
- Digoxin: Invokana may increase blood levels of digoxin, so patients taking both should be monitored for signs of digoxin toxicity.
Alternatives to Invokana
- Farxiga (dapagliflozin): Another SGLT2 inhibitor used to lower blood sugar levels in patients with type 2 diabetes and to protect the kidneys and heart.
- Jardiance (empagliflozin): An SGLT2 inhibitor similar to Invokana, also used to manage blood sugar and reduce cardiovascular risks.
- Metformin: A first-line oral medication for type 2 diabetes that lowers blood sugar by improving insulin sensitivity.
- Glipizide (sulfonylurea): An oral antidiabetic that increases insulin production in the pancreas.
