Invokana
Invokana (canagliflozin) is a medication that's used together with a healthy diet and exercise to lower blood sugar levels in adults with Type 2 diabetes. It can also lessen the chance of worsening heart and kidney problems in some people with Type 2 diabetes. This medication is taken by mouth once a day.
What is Invokana (canagliflozin)?
What is Invokana (canagliflozin) used for?
- Type 2 diabetes
- Lowering the risk of major heart events (e.g., heart attack, stroke) in adults with Type 2 diabetes and heart disease
- Lowering the risk of hospitalization for heart failure, death due to heart problems, and worsening of kidney problems in certain adults with Type 2 diabetes and diabetic kidney disease
How Invokana (canagliflozin) works
Invokana (canagliflozin) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. It works in the kidneys to prevent the absorption of sugar and sodium (salt) back into your body. It lowers blood sugar by causing your body to get rid of excess sugar through your urine. And by preventing sodium reabsorption, the heart fills with blood easier and has an easier time pumping blood throughout the body. This might also improve blood flow through the kidneys and slow the worsening of kidney problems.
Drug facts
Side effects of Invokana (canagliflozin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Vaginal yeast infection in females (11-12%)
- Urinary tract infections (UTIs; 4-6%)
- More urination (5%)
Less Common Side Effects
- Vaginal itching
- Male genital yeast or fungal infections
- Thirst
- Constipation
- Nausea
Invokana (canagliflozin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe allergic reaction: rash; trouble breathing; swelling of the face, lips, tongue, or throat
- High ketone levels in the blood: nausea, vomiting, stomach pain, tiredness, thirsty, dry mouth, fruity breath, trouble breathing
More on Invokana (canagliflozin) side effects
The following Invokana (canagliflozin) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bladder pain
bloody or cloudy urine
decreased frequency or amount of urine
difficult, burning, or painful urination
discharge with a strong odor from the penis
frequent urge to urinate
increased thirst
increased urge to urinate during the night
indigestion
itching of the vagina or outside of the genitals
loss of appetite
lower back or side pain
pain during sexual intercourse
pain in the skin around the penis
problems in urination or increase in amount of urine
redness, itching, or swelling of the penis
swelling of the face, fingers, or lower legs
thick, white vaginal discharge with mild or no odor
trouble breathing
unusual tiredness or weakness
vomiting
waking to urinate at night
Less common
blurred vision
chills
cold sweats
confusion
cool, pale skin
dizziness
fast or irregular heartbeat
flushing, redness of the skin
headache
hives or welts, itching skin, rash
increased hunger
itching skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
nightmares
redness of the skin
seizures
shakiness
slurred speech
unusually warm skin
Incidence not known
Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
flushed, dry skin
frequent or painful urination
fruit-like breath odor
increased urination
loss of consciousness
numbness or tingling in the hands, feet, or lips
pain, tenderness, redness, or swelling of the area between the anus and genitals
stomach pain
sweating
unexplained weight loss
weakness or heaviness of the legs
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Difficulty having a bowel movement
falls
lack or loss of strength
pain or swelling in the arms or legs without an injury
Rare
Increased sensitivity of the skin to sunlight
redness or other discoloration of the skin
severe sunburn
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Invokana (canagliflozin)
Pros
- Only taken once a day
- Can use alone or together with other diabetes medications
- Dose can be adjusted based on how well the medication is working for you
Cons
- Only available as brand only
- Might raise the risk of genital infections or bone fracture
- Not recommended in second and third trimesters of pregnancy
- Unknown if safe or works well in people on dialysis
Pharmacist tips for Invokana (canagliflozin)
- Invokana (canagliflozin) works best on an empty stomach. So it's recommended to take it every morning before the first meal of the day.
- If you miss your dose of Invokana (canagliflozin), take it as soon as possible. If it's almost time for your next dose, skip the missed dose and continue with your treatment as prescribed. Don't double up to make up for a missed dose since this could lead to side effects.
- Be sure to drink plenty of fluids because Invokana (canagliflozin) can raise your risk for dehydration (low fluids in the body). If you feel dizzy, let your provider know.
- Practice good hygiene to prevent yeast and urinary tract infections, since Invokana (canagliflozin) can put you at a higher risk for these problems. Wear breathable, cotton underwear. Shower and change clothes as soon as possible after exercising or after a hot day.
- Check your blood sugar if you don't feel well or feel dizzy, shaky, or weak. These can be signs of low blood sugar. Talk with your provider about how to treat low blood sugar (less than 70 mg/dL) and when you need to call 911.
- Tell your provider if you become pregnant while taking Invokana (canagliflozin). It's also not recommended to breastfeed during treatment. Invokana (canagliflozin) can potentially cause harm to babies.
Common questions about Invokana (canagliflozin)
In clinical studies, Invokana (canagliflozin) lowered A1C (a blood test that measures your average blood sugar level over time) by about 0.8% to 1%, depending on the dose. This result happened in people with Type 2 diabetes who took Invokana (canagliflozin) along with a healthy diet and exercise for 6.5 months (26 weeks). They didn't take any other diabetes medications during the study. Your results might be different, since not everyone responds to treatment the same. Make sure to follow up with your provider to discuss your progress with Invokana (canagliflozin).
Invokana (canagliflozin) can raise your risk for genital yeast infections. In females, symptoms include vaginal itching; white, thick discharge; and pain in the vagina or when urinating. In males, symptoms include redness, itching, or swelling of the penis. If you experience any of these symptoms, contact your provider. There are a few ways to help prevent yeast infections, including wearing cotton underwear, avoiding tight underwear or pants, and changing out of wet or sweaty clothes as soon as possible.
Invokana (canagliflozin) might raise your risk of needing a lower limb amputation. These amputations can involve the removal of the toe, part of the foot, leg, or below or above the knee. How Invokana (canagliflozin) raises this risk isn't yet clearly understood. But a history of previous amputations, nerve damage in your leg, or foot ulcers or sores might also raise your risk. It's very important to talk to your provider if you experience any leg or foot pain while taking Invokana (canagliflozin) so they can check it out before it gets any worse.
In clinical studies, people taking Invokana (canagliflozin) saw a reduction in their weight by about 2% to 3% over time. While it's possible to experience weight loss during treatment, note that Invokana (canagliflozin) hasn't been FDA approved for weight loss. Speak to your provider about appropriate weight management plans if you're looking to lose weight, and continue to eat healthy and exercise regularly.
No. Invokana (canagliflozin) and metformin are two different medications that work well to manage and treat Type 2 diabetes. Both medications can be used by themselves to lower blood sugar levels, but they can also be used together for a possibly greater effect. This is because Invokana (canagliflozin) and metformin work differently to lower blood sugar levels. Metformin works by slowing down glucose (sugar) production in the liver, lowering absorption of glucose from your gut, and improving your body's response to insulin. Invokana (canagliflozin) works by blocking absorption of glucose in your kidneys and removing it from your body through your urine. While metformin is available as a brand name and generic, Invokana (canagliflozin) is currently only available as a brand-name medication. Talk to your provider to find the right medication for you.
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Risks and warnings for Invokana (canagliflozin)
Invokana (canagliflozin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Leg and foot amputations
- Risk factors: History of amputations | Lower limb infection | Peripheral vascular disease (narrowed blood vessels) | Nerve problems | Diabetic foot ulcers
Although rare, Invokana (canagliflozin) can raise your risk of needing foot or leg amputations. Your risk might be higher if you have a history of amputation, blood vessel problems, or nerve problems. In studies, the most common reasons for amputations for people who took Invokana (canagliflozin) were leg infections, damaged leg tissue, and diabetic foot ulcers. Let your provider know 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.
Ketoacidosis
- Risk factors: Type 2 diabetes | Higher dose of Invokana (canagliflozin) | Illness | Alcohol abuse | Lowered calorie intake | Insulin dose reduction | Pancreatic problems | Surgery
Some people with diabetes taking Invokana (canagliflozin) have experienced a serious condition called ketoacidosis. This can be life-threatening and happens when your body makes too many ketones, which makes your blood acidic. Your risk might be higher if you're eating less calories, taking a higher dose of Invokana (canagliflozin), are ill, have recently had surgery, or have had a recent reduction in your insulin dose. 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.
Low fluids in the body (leading to low blood pressure or dehydration)
- Risk factors: 65 years or older | Kidney problems | Taking loop diuretics (water pills) | Low-sodium diet
Invokana (canagliflozin) can cause low levels of fluids in the body. Low fluids can lead to low blood pressure or kidney injury. Your risk is higher if you already have kidney problems, are 65 years or older, are on a low-sodium diet, or take water pills known as loop diuretics. Your provider will check your kidneys with blood tests to make sure they're working properly. Stay hydrated while you're taking this medication. Contact 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 from your body.
Genital and urinary tract infections
- Risk factors: History of genital yeast infections or urinary tract infections (UTIs)
Invokana (canagliflozin) raises the risk of genital infections, like UTIs and yeast infections. In some cases, these infections can become serious and require hospitalization. Call 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.
Low blood sugar (hypoglycemia) when used with certain other diabetes medications
- Risk factors: Changes in diet and exercise | Drinking alcohol | Taking certain other medications for diabetes
Invokana (canagliflozin) can raise your risk for low blood sugar when taken together with certain other diabetes medications, such as insulin or sulfonylureas like glipizide. Very low blood sugar 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. Be sure to check your blood sugar if you experience any of these symptoms.
Severe allergic reactions
In some rare cases, Invokana (canagliflozin) can cause serious allergic reactions. If you experience a rash; trouble breathing; or swelling of your face, lips, tongue, or throat; get medical help right away.
Bone fractures
Invokana (canagliflozin) 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.
Invokana (canagliflozin) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100mg | 30 tablets | $583.67 | $19.46 |
| 300mg | 30 tablets | $583.72 | $19.46 |
Typical dosage for Invokana (canagliflozin)
The typical starting dose is 100 mg by mouth once daily before your first meal of the day. Your provider might raise your dose to 300 mg daily depending on how well the medication is working for you.
Your dose might differ if you have kidney problems. It also might differ if you're taking certain medications like rifampin (Rifadin), phenytoin (Dilantin), phenobarbital, or ritonavir (Norvir).
Interactions between Invokana (canagliflozin) and other drugs
More on Invokana (canagliflozin) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Balofloxacin
- Besifloxacin
- Chloroquine
- Ciprofloxacin
- Digoxin
- Enoxacin
- Fleroxacin
- Flumequine
- Gatifloxacin
- Gemifloxacin
- Hydroxychloroquine
- Lanreotide
- Levofloxacin
- Lomefloxacin
- Moxifloxacin
- Nadifloxacin
- Norfloxacin
- Octreotide
- Ofloxacin
- Pasireotide
- Pazufloxacin
- Pefloxacin
- Prulifloxacin
- Rufloxacin
- Sparfloxacin
- Thioctic Acid
- Tosufloxacin
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Atenolol
- Betaxolol
- Bisoprolol
- Carteolol
- Carvedilol
- Celiprolol
- Esmolol
- Labetalol
- Levobunolol
- Metipranolol
- Metoprolol
- Nadolol
- Nebivolol
- Oxprenolol
- Penbutolol
- Pindolol
- Practolol
- Propranolol
- Sotalol
- Timolol
How much does Invokana (canagliflozin) cost?
$583.67
Invokana (canagliflozin) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Invokana (canagliflozin) will not be safe for you to take.
- On dialysis
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