Invokana

The active ingredient in Invokana is canagliflozin. Canagliflozin belongs to a class of diabetes medicines known as SGLT2 inhibitors or sodium-glucose co-transporter inhibitors. These drugs stop the kidneys from reabsorbing sugar so that more is excreted in the urine. With this mechanism of action, SGLT2 inhibitors effectively lower blood glucose.

In addition to managing hyperglycemia (high blood sugar levels), Invokana has protective effects on kidney function and cardiovascular health. As people with diabetes are already at an increased risk for renal/kidney disease and cardiovascular disease, Invokana provides further benefits in addition to managing high blood sugar. Invokana has also been seen to result in weight loss, further improving the health of diabetics.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-approved product labeling, Instructions for Use, and Medication Guide before using Invokana. However, the following is a synopsis of the general guidelines for the use of Invokana:

• Invokana is typically taken by mouth daily as a 100 mg or 300 mg dose with your first meal of the day.
• Take exactly as prescribed. Do not exceed the recommended dose or duration of use.
• Your healthcare provider may have you take Invokana alongside your other diabetes medicines like metformin for better blood sugar management.
• Because of the way Invokana works, your urine will test positive for glucose. Therefore, your healthcare provider may test your glycemic or blood sugar control through other lab tests such as HbA1C.
• Because Invokana has an increased risk of diabetic ketoacidosis, your healthcare provider may have you monitor your blood ketone levels.
• If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

The most common side effects of Invokana seen in clinical trials as compared to placebo include:

• Urinary tract infections (UTIs)
• Increased urination
• Vaginal or male genital yeast infections

Some individuals may experience serious side effects while using Invokana. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Signs of an allergic reaction such as trouble breathing, hives, rash, or swelling of the face, eyes, tongue, lips, or throat.
• Increased risk of bone fractures.
• Signs of diabetic ketoacidosis (DKA) such as nausea, stomach pain, fatigue, fruit breath, or trouble breathing. DKA is a life-threatening condition and can result in death if left untreated.
• Increased risk of lower limb amputations and any new pain, tenderness, or changes to the skin (sore, ulcers, or infections) should be reported to your healthcare provider.
• Signs of severe dehydration such as dizziness, weakness, feeling lightheaded when going from sitting to standing, and low blood pressure (hypotension).
• Signs of a serious UTI such as fever, blood in the urine, flank pain, and lower back pain.
• Signs of dangerously low blood sugar (hypoglycemia) such as headache, tremors, jitteriness, sweating, confusion, irritability, or weakness. The risk of hypoglycemia is higher when Invokana is used with other diabetes medicines.
• Signs of necrotizing fasciitis of the perineum (otherwise known as Fournier’s gangrene). This is a serious bacterial infection in the area between and around the anus and genitals. Report any symptoms of pain, tenderness, swelling, or redness of the skin in that area.

These are not all of the possible side effects of Invokana. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Invokana, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if any of the following apply to you:

• Type 1 diabetes
• A history of diabetic ketoacidosis
• Decreased your insulin dose
• A serious infection
• A history of UTIs
• Problems with urination
• History of a vaginal or genital infection
• A previous amputation
• Blocked or narrowed blood vessels
• Heart disease
• Neuropathy or damaged nerves
• Diabetic foot ulcers or sores
• Kidney problems or a low eGFR
• Liver problems
• Pancreas problems
• A low-salt diet
• Made changes to your diet or are eating less
• Dehydration
• An upcoming surgery or procedure that requires fasting
• Drink alcohol
• Are pregnant or plan to become pregnant
• Are breastfeeding or plan to breastfeed

Do not use Invokana if you have an allergy to canagliflozin or any other inactive ingredients in the product or are on dialysis.

It can take a couple of weeks for your blood sugar levels to respond to Invokana. However, everyone is different and some may see benefits earlier or later.

When Invokana is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Insulin
• Diuretics or a water pill like furosemide
• Sulfonylureas
• Rifampin
• Phenytoin
• Phenobarbital
• Ritonavir
• Digoxin
• Lithium

Invokana tablets are available in the following strengths:

• 100 mg tablet
• 300 mg tablet

Invokana should be stored at room temperature away from light and out of reach of children.

Invokana is manufactured by the pharmaceutical company Janssen Pharmaceuticals.

There is currently no generic version of the brand name Invokana available.

Consult your doctor or pharmacist before starting, stopping, or changing medications while taking Invokana. Stopping this medication abruptly can cause your blood sugar to increase, which can lead to serious complications.

Invokana may cause harm to the unborn child and is not recommended during the second and third trimesters of pregnancy. Talk to your doctor if you are already pregnant or if you have any plans to become pregnant. They will know or recommend what is best for you.

Invokana can pass into the breast milk and may harm your breastfed infant. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend the best way for you to feed your infant.