What’s Invokana? 10 Things You Need to Know

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Invokana (canagliflozin) is one of the new oral medications for adult onset diabetes. It’s expensive but has many upsides. Taken usually in combination with metformin it is a rising star in the treatment of diabetes. Here is what you need to know to help you decide: worth it or not?

  1. Invokana is taken as a 100 mg tablet once daily before breakfast, increasing to a 300 mg tablet once a day if you have normal kidney function. Invokana can be taken with or without food.
  1. Invokana is not yet recommended for use alone in the treatment of diabetes; it should be given as a second agent in addition to metformin or as a third-line treatment.
  1. Invokana works on the kidneys and tells the proximal tubule to resorb approximately 90 percent of the filtered glucose load. So, Invokana promotes dumping of glucose from the kidneys to the urine.
  1. Invokana used alone doesn’t lower blood sugars (measured by the A1C blood test) enough to make it effective as a single agent for diabetes. In studies it lowers A1C by 0.5 to 0.7 percentage points, making it a relatively weak glucose lowering agent.
  1. Invokana alone is similar in potency to the DPP-4 inhibitors (Januvia, Onglyza, Tradjenta).
  1. When should Invokana be added? It has been shown to be effective in lowering A1C when metformin alone is not achieving the goal A1C of < 7.0. Invokana 300 mg compared to Januvia 100 mg mixed with metformin was better at lowering blood sugar and helped with weight loss.
  1. Will I lose weight on Invokana? Yes, in most studies Invokana (used with metformin) resulted in a 6.5 pound weight loss at 12 weeks and an almost 10 pound weight loss at the end of a year. That’s quite a plus.
  1. The huge downside of Invokana is the frequency of genital fungal infections, which are almost sixfold higher. This means there is an increased risk of genital yeast infections: vulvovaginal candidiasis (vaginal yeast infections) in women but also male yeast infections, which carries a higher risk in uncircumcised males. There is also a small increased risk of urinary tract infections.
  1. Invokana can also raise potassium.
  1. Does Invokana cause low sugars/hypoglycemia? No, not really. Thats another benefit as hypoglycemia can get you into trouble with some of the older meds and insulin. The overall benefits of Invokana include a decrease in blood pressure and weight, and a low incidence of hypoglycemia when used alone or with metformin.

Any takers?

Dr O.

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