Invokana (generic name: canagliflozin) is a prescription medication used to treat type 2 diabetes mellitus. It belongs to a class of drugs known as sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Invokana works by inhibiting the SGLT2 protein in the kidneys, which is responsible for reabsorbing glucose back into the bloodstream. By blocking this protein, Invokana allows excess glucose to be excreted in the urine, leading to a reduction in blood sugar levels. This mechanism of action helps to improve glycemic control in individuals with type 2 diabetes.

Precautions and Warnings with Invokana

Safety Information

  • Invokana is not intended for the treatment of type 1 diabetes or diabetic ketoacidosis.
  • Patients with a history of hypersensitivity reactions to canagliflozin or any of the ingredients in Invokana should not take this medication.
  • Invokana may increase the risk of urinary tract infections (UTIs) and genital yeast infections.
  • Dehydration may occur with Invokana use, especially in elderly patients or those with renal impairment.
  • Invokana may cause hypotension (low blood pressure), particularly in patients taking diuretics or medications that lower blood pressure.
  • Use of Invokana may lead to an increased risk of bone fractures, particularly in patients with a history of fractures or those with conditions affecting bone health.

Contraindications

  • Patients with severe renal impairment (eGFR less than 30 mL/min/1.73 m²)
  • Patients with end-stage renal disease (ESRD) requiring dialysis
  • Patients with a history of diabetic ketoacidosis
  • Patients with a history of hypersensitivity reactions to canagliflozin or any of the ingredients in Invokana

Special Precautions for Use

  • Healthcare providers should assess renal function before initiating Invokana and periodically thereafter.
  • Patients should be counseled on the signs and symptoms of ketoacidosis and instructed to seek medical attention if they develop such symptoms (e.g., difficulty breathing, nausea, vomiting).
  • Patients with a history of genital yeast infections or UTIs should be monitored closely for recurrence while taking Invokana.
  • Elderly patients and those with hepatic impairment may be more susceptible to adverse effects of Invokana and should be monitored closely for complications.

Invokana Side Effects

While Invokana is generally well-tolerated, like any medication, it may cause side effects in some individuals. Side effects associated with Invokana may include:

Common Side Effects

  • Urinary tract infections
  • Urinating more often than normal
  • Thirstiness
  • Constipation
  • Nausea
  • Yeast infections in men and women
  • Vaginal itching

Serious Side Effects

  • Dehydration (low fluid level), which can cause low blood pressure. Symptoms can include:
    • Dizziness
    • Feeling faint
    • Lightheadedness
    • Weakness, especially when you stand up
  • Hypoglycemia (low blood sugar level). Symptoms can include:
    • Drowsiness
    • Headache
    • Confusion
    • Weakness
    • Hunger
    • Irritability
    • Sweating
    • Feeling jittery
    • Fast heartbeat
  • Severe allergic reaction
  • Amputation of lower limbs
  • Diabetic ketoacidosis (increased levels of ketones in your blood or urine)
  • Fournier’s gangrene (severe infection near the genitals)
  • Kidney damage
  • Bone fractures

Drug Interactions with Invokana

Invokana may interact with other medications, supplements, or substances, potentially affecting its effectiveness or increasing the risk of adverse effects. Some notable drug interactions with Invokana may include:

  1. Diuretics: Concurrent use of diuretics (e.g., furosemide, hydrochlorothiazide) may increase the risk of dehydration and electrolyte imbalances when used with Invokana.
  2. Insulin and Insulin Secretagogues: The risk of hypoglycemia (low blood sugar) may be increased when Invokana is used concomitantly with insulin or insulin secretagogues (e.g., sulfonylureas).
  3. ACE Inhibitors and ARBs: Concomitant use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may increase the risk of hyperkalemia (high blood potassium levels) when used with Invokana.
  4. NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may decrease the diuretic and blood pressure-lowering effects of Invokana.
  5. Rifampin: Rifampin, an antibiotic used to treat tuberculosis and other infections, may reduce the effectiveness of Invokana and should be used cautiously together.

Invokana Strengths and Dosages

Available Strengths

Invokana is available in tablet form for oral administration in the following strengths:

  • 100 mg tablets
  • 300 mg tablets

Recommended Dosages

  • The usual starting dose of Invokana is 100 mg taken orally once daily.
  • For patients who require additional glycemic control, the dosage may be increased to 300 mg once daily.
  • Invokana can be taken with or without food, and the tablet should be swallowed whole with a glass of water.

Cost of Invokana in America

At this time of writing, the cost for Invokana oral tablet 100 mg to be approximately $640 for a supply of 30 tablets.

Patients are encouraged to check with their local pharmacies, insurance providers, or explore patient assistance programs to determine the most cost-effective option for obtaining Invokana.

Why Is Invokana So Expensive?

  • Research and Development Costs: Pharmaceutical companies invest significant resources in the research and development of new medications, including clinical trials and regulatory approval processes, which can contribute to the overall cost of the drug.
  • Manufacturing and Distribution Expenses: The production and distribution of pharmaceutical products entail expenses related to manufacturing facilities, quality control processes, and transportation, which can impact the final cost of the medication.
  • Patent Protection: Brand-name medications like Invokana are typically protected by patents, which grant exclusive rights to the manufacturer to market and sell the drug for a specified period. During this time, generic versions of the medication are not available, allowing the manufacturer to set higher prices.
  • Marketing and Promotion: Pharmaceutical companies often invest in marketing and promotional activities to raise awareness of their medications among healthcare providers and patients, which can add to the overall cost of the drug.

Invokana Alternatives

While Invokana is an effective treatment for type 2 diabetes, there are alternative medications available that may be considered based on individual patient factors and preferences. Some alternative medications for the management of type 2 diabetes may include:

  • Metformin: Metformin is a first-line medication for the treatment of type 2 diabetes and is often used as initial therapy or in combination with other antidiabetic agents. It works by reducing glucose production in the liver and improving insulin sensitivity in peripheral tissues.
  • SGLT2 Inhibitors: Like Invokana, other SGLT2 inhibitors such as dapagliflozin (Farxiga) and empagliflozin (Jardiance) are available for the treatment of type 2 diabetes. These medications have a similar mechanism of action, helping to lower blood sugar levels by increasing urinary glucose excretion.
  • GLP-1 Receptor Agonists: Glucagon-like peptide-1 (GLP-1) receptor agonists such as liraglutide (Victoza) and dulaglutide (Trulicity) are injectable medications that stimulate insulin secretion and inhibit glucagon release, leading to improved glycemic control and potential weight loss.
  • DPP-4 Inhibitors: Dipeptidyl peptidase-4 (DPP-4) inhibitors such as sitagliptin (Januvia) and saxagliptin (Onglyza) work by increasing insulin secretion and decreasing glucagon levels, resulting in lower blood sugar levels in patients with type 2 diabetes.
  • Insulin Therapy: For patients with more advanced or poorly controlled type 2 diabetes, insulin therapy may be necessary to achieve target glycemic goals. Various types of insulin formulations are available, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins, which can be used alone or in combination to tailor treatment to individual needs.

FAQs of Invokana

What is Invokana?

Invokana is a prescription medication containing the active ingredient canagliflozin. It belongs to a class of drugs known as sodium-glucose cotransporter 2 (SGLT2) inhibitors, used for the treatment of type 2 diabetes mellitus.

What is Invokana used for?

Invokana is used to improve glycemic control in adults with type 2 diabetes by helping to lower blood sugar levels.

Who makes Invokana?

Invokana is manufactured by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson.

How long does Invokana stay in your system?

The elimination half-life of Invokana is approximately 10.6 hours. This means it takes about 10.6 hours for half of the medication to be eliminated from the body.

What should I know about the management of yeast infections while taking Invokana?

Patients taking Invokana should be aware of the potential risk of genital yeast infections. It is important to practice good hygiene and promptly seek medical attention if symptoms such as itching, burning, or unusual discharge occur.

When will Invokana go generic?

Generic versions of Invokana may become available after May 11, 2031.

How do I know if Invokana is working?

Patients may notice improvements in their blood sugar levels and overall glycemic control while taking Invokana. Regular monitoring of blood glucose levels and discussions with healthcare providers can help assess the effectiveness of treatment.

What’s the difference between Invokana and Invokamet?

FeatureInvokanaInvokamet
Active IngredientsCanagliflozinCanagliflozin and Metformin
Mechanism of ActionSGLT2 InhibitorSGLT2 Inhibitor and Biguanide
Available Dosages100 mg, 300 mgVaries (combination tablets)
AdministrationOral tabletsOral tablets
Single or CombinationSingleCombination

What should I know about stopping Invokana? Will I have withdrawal symptoms?

Patients should not stop taking Invokana without consulting their healthcare provider. Abrupt discontinuation of Invokana is not recommended and may lead to a rebound increase in blood sugar levels. Patients should work with their healthcare provider to gradually taper off Invokana if discontinuation is necessary and closely monitor blood glucose levels during the transition.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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