Invokamet

• Risk factors: Age 65 or older | Kidney problems | Liver problems | Heart problems | Dehydration (low fluids in the body) | Taking certain medications | Alcohol use | Imaging procedure using contrast dye | Surgery

Invokamet (canagliflozin / metformin) contains metformin, a medication that can, on rare occasions, cause a condition called lactic acidosis (too much lactic acid in your blood). This condition can lead to other health problems that can be deadly if not treated right away. Certain medications, like topiramate (Topamax), zonisamide (Zonegran), and acetazolamide, can raise your risk for lactic acidosis. Tell your provider about any health problems you have and other medications you take before starting Invokamet (canagliflozin / metformin).

Get medical help immediately if you experience trouble breathing; fast breathing; upset stomach; feeling very weak, tired, or dizzy; feeling cold in your hands or feet; or unusual muscle pain. These can be signs of too much lactic acid in your blood.

• Risk factors: History of amputations | Lower limb infection | Heart problems | Peripheral vascular disease (narrowed blood vessels) | Nerve problems | Diabetic foot ulcers

Although rare, Invokamet (canagliflozin / metformin) might raise your risk of needing foot or leg amputations (removal of a body part). Your risk might be higher if you have a history of amputation, heart or blood vessel problems, or nerve problems. In studies, the most common reasons for amputations for people who took canagliflozin (an ingredient in Invokamet) were leg infections, damaged leg tissue, and diabetic foot ulcers. Call your provider if you experience any new pain, tenderness, sores, ulcers, or infections on your legs or feet. Your provider can recommend ways to manage these foot problems or treat them before they get worse. Follow up with your provider regularly so they can perform foot exams.

• Risk factors: Type 2 diabetes | High dose of canagliflozin | Illness | Alcohol abuse | Lowered calorie intake | Insulin dose reduction | Pancreatic problems | Surgery

Some people taking Invokamet (canagliflozin / metformin) have experienced a serious condition called ketoacidosis. This happens when your body makes too many ketones, which makes your blood acidic. In some cases, it could be life-threatening. Your risk might be higher if you're ill, eating less calories, taking a higher dose of canagliflozin, drinking a lot of alcohol, have recently had surgery, or have had a recent reduction in your insulin dose. If possible, check your ketones if you experience dry mouth, fruity breath, tiredness, nausea, vomiting, stomach pain, or trouble breathing. Get medical help right away if any of these symptoms happen.

• Risk factors: 65 years or older | Kidney problems | Taking loop diuretics (water pills) | Low-sodium diet

Invokamet (canagliflozin / metformin) can cause low levels of fluids in the body. This can lead to dehydration, low blood pressure, or kidney damage. Your risk is higher if you already have kidney problems, are 65 years or older, are on a low-sodium diet, or are taking water pills known as loop diuretics. Your provider will check your kidney health with blood tests. Make sure to stay hydrated while you're taking Invokamet (canagliflozin / metformin). Call your provider if you experience dizziness or if you're urinating less than usual. Also tell them if you have vomiting or diarrhea so they can make sure you're not losing too much fluid.

• Risk factors: History of genital yeast infections or urinary tract infections (UTIs)

Invokamet (canagliflozin / metformin) raises the risk of genital infections, like UTIs and yeast infections. In some rare cases, these infections can become serious and require hospitalization. Contact your provider if you experience a burning feeling when urinating; a need to urinate often; lower stomach pain; blood in your urine; an odor from your genitals; or pain, itching, swelling, redness, or tenderness around your genitals.

• Risk factors: Changes in diet and exercise | Drinking alcohol | Taking certain other medications for diabetes

Invokamet (canagliflozin / metformin) can raise your risk for low blood sugar when taken together with certain other diabetes medications, such as insulin or sulfonylureas like glipizide. In some cases, this can be life threatening. Symptoms of low blood sugar include being nervous or anxious; feeling shaky, sleepy, weak, or confused; having a fast heartbeat; sweating; and excessive hunger. Check your blood sugar if you experience any of these symptoms and know when you should call 911.

In some rare cases, Invokamet (canagliflozin / metformin) can cause serious allergic reactions. If you experience a rash; hives; trouble breathing; or swelling of your face, lips, tongue, or throat; get medical help right away.

Invokamet (canagliflozin / metformin) can raise your risk for bone fractures. This can happen 3 months after starting the medication. Ask your provider about ways to keep your bones healthy.

• Risk factors: Long-term use | Low calcium absorption | Low vitamin B12 absorption

Some people taking metformin (an ingredient in Invokamet (canagliflozin / metformin)) can have low levels of vitamin B12. Low vitamin B12 levels can lead to anemia (low red blood cells). Let your provider know about any persistent low energy, muscle weakness, low appetite, and tingling or numbness in your hands or feet. A blood test can help determine if you have low vitamin B12 levels. Make sure to keep up with your routine lab work so your provider can keep track of your vitamin B12 levels and blood counts.