INVOKANA (Canagliflozin): Detailed Side Effects and Uses of Invokana

By Miriatu


Invokana (canagliflozin) was developed by Mitsubishi Tanabe Pharma in 2012 and is marketed by Janssen Pharmaceuticals, a division of Johnson & Johnson. In March of 2013, the FDA approved it for treatment of type 2 diabetes. It was the first SGLT2 inhibitor to be approved in the United States of America. America FDA Approves Invokana™ (Canagliflozin) for the treatment of adults with type 2 diabetes. Invokana is the first in a new class of type 2 diabetes medications available in the United States in phase 3 studies.


Through this article you will be able to acquire all the relevant information surrounding the drug Invokana with regards the following areas such as the side effects of Invokana, uses of Invokana, and the dosage of Invokana.




Description of Invokana


Invokana (canagliflozin) is an oral diabetes medicine that helps control blood sugar levels. Canagliflozin operates by assisting the kidneys get rid of glucose from your bloodstream. Invokana is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes. Mind you Invokana is not formulated for treating type 1 diabetes. It is also important to note that you should not use Invokana if you have severe kidney disease (or if you are on dialysis). The antidiabetic drug (Invokana) causes the body to pass out glucose from the blood through the urine, which implies that the energies in the glucose are sent out. This action also helps in strengthening the loss of weight, when the drug is used in combination with a healthy diet and regular physical activity.




What is type 2 diabetes?       


Type 2 diabetes is a situation in which your body does not make large insulin, and the insulin that your body produces does not work as well as it ought to. It could also be as the result of your body producing too much sugar. When this occurs, glucose (sugar) levels increase in the blood and is not controlled, it can lead to serious medical conditions such as kidney disease or failure, blindness, heart disease, and amputation.




Dosage of Invokana


Here you will be introduced to proper dosage of Invokana, overdose and missed dose respectively.


  • Proper dosage of Invokana: 100 mg by mouth each day with or without food. Your doctor may increase your dose to 300 mg. However, if you have a kidney problem, your doctor may limit your dose to100 mg. It is best to take Invokana before the first meal of the day and at the same time every day. Take the tablet complete alongside water. (Talk to your doctor for the best dosage of Invokana for your particular need)
  • Overdose with Invokana: In the situation of taking the drug beyond the prescribed dose (i.e. overdose), get a healthcare practitioner, the emergency department or regional Poison Control Centre immediately, and don’t wait to see the signs and symptoms.
  • Missed dose: If you forget to take a dosage of Invokana, take it as soon as you recall. But, if it is almost the moment for the following dose, skip the missed dose and follow your usual schedule. Do not take a double dose (two doses on the same day) to make up for a forgotten dose.


Storage Conditions


This medicine does not require any special storage conditions.Store at room temperature (15-30°C). Keep this medicine out of the reach and sight of children. Do not use this drug after the expiry date which is stated on the carton or label after EXP and on the blister. The expiry date is considered as the last day of a month. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw medicine you no longer take. These tips will enable protect the environment around you.


Uses of Invokana


Invokana uses go along with diet and exercise to control blood sugar levels in adults with type 2 diabetes. The various uses of Invokana are discussed below:


Invokana contains the active substance canagliflozin which belongs to a group of medicine called blood glucose lowering drugs. Blood glucose lowering drugs are medicines used by adults to treat type 2 diabetes. This medicine works by increasing the amount of sugar removed from your body in your urine. This reduces the amount of sugar in your blood.


Invokana can be used alone or along with other medicines to treat type 2 diabetes patients. Such drug combination include metformin, insulin, a DPP-4 inhibitor such as sitagliptin, saxagliptin or linagliptin, a sulphonylurea such as glimepiride or glipizide or pioglitazone that lower blood sugar levels.


If you are already on one or more of these medicines to treat your type 2 diabetes then it is important to keep following advice about diet and exercise given by your doctor or nurse.


By these uses of Invokana, it means that Invokana function by accelerating the quantity of sugar removed from the body, which helps to lower the proportion of sugar in the blood. Invokana is formulated for used only in the treatment of type 2 diabetes and not effective for diabetes type 1.




Side effects of Invokana


Here you will be ushered to both the common and uncommon side effects of Invokana. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be severe and mild or, temporal and permanent.


Common Side effects of Invokana


  • Rash or redness of the foreskin of the penis (yeast infection or banalities)
  • Urinary tract infection or problem (like a burning sensation when urinating, cloudy urine, strong odor).
  • Dysfunctioning in urination like frequent urinating or in larger proportion, an urgent need to urinate, and a need to urinate at night
  • Nausea.
  • Constipation.
  • Feeling thirsty showcases Invokana side effects.
  • Blood tests may show changes in cholesterol (blood fat) levels and increases in amount of red blood cells in your blood (haematocrit)
  • Blurred vision
  • Tingling lips
  • Trembling, sweating, pale looking
  • A change in mood such as feeling anxious or confused
  • Confusion
  • Unusual sleepiness or tiredness
  • A different odour or taste to your urine or sweat.




Dehydration reflects uncommon Invokana side effects that may affect up to 1 in 100 people. (Not having the required water in your body) shows palpable side effects of Invokana. Dehydration occurs more often in older people (aged greater than 75 years), people with kidney problems, and people taking water tablets (diuretics). Discuss with your doctor about what you can do to stop dehydration. The possible signs of dehydration are:


  • Feeling light headed or dizzy
  • Passing out, (fainting) or feeling dizzy or faint when you stand up
  • Very dry or sticky mouth, feeling very thirsty
  • Feeling very weak or tired
  • Passing little or no urine
  • Fast heartbeat when you stand up, have low blood pressure, feeling thirsty, tired or weak





Effects of overdose with Invokana:


It is unclear what exactly to expect from an Invokana overdose. Actually, there have not been any satisfactory documented clinical findings on the overdoses of Invokana. However, due to the unknown functions of the drug, it might be rational to anticipate that the following problems might occur.


  • Dehydration
  • Low blood pressure (hypotension)
  • ( Hyperkalemia) or high blood potassium levels
  • Yeast infections in women or genital fungal infections in uncircumcised men
  • Low blood sugar





Treatment for an Invokana Overdose


At this time, it is unclear how best to treat this type of overdose. If the over dosage was recent, your doctor or healthcare provider might administer certain medicines or place a tube into the stomach to “clean the stomach.” Dialysis is not necessary for taking off Invokana from the bloodstream. Therapy may equally consist of supportive care, which consists of treating the signs that occur as a result of the overdose. This may consist of:


  • Close follow-up of electrolytes and blood sugar
  • Close monitoring of vital signs, especially blood pressure and heart rate.


Conclusively, it is important that you seek medical attention immediately if you believe that you may have overdosed on this drug.




Invokana Uses in specific populations


Pregnancy: Based on animal data showing adverse renal effects, Invokana is not approved within the second and third trimesters of pregnancy. Limited data with Invokanain pregnant women are not sufficient to determine a drug-associated risk for major miscarriage or birth defects. There are risks to mother and fetus associated with poorly controlled diabetes in pregnancy.


Nursing mothers: There is no information regarding the presence of Invokana in the milk of human, the effects on milk production or the effects on the breastfed infant. Due to the potential for severe adverse reactions in a breastfed infant, advice women that the use of Invokana is not recommended while breastfeeding.


Pediatric use: Effectiveness and safety and in patients less than 18 years of age have not been developed.


Geriatric use: 2034 patients greater than and equal to 65 years and 345 patients greater than and equal to 75 years were exposed to Invokana in 9 clinical studies. Patients greater than and equal to 65 years had a higher incidence of adverse reactions related to reduced intravascular speed (e.g., orthostatic hypotension, hypotension, dehydration syncope), postural dizziness, particularly with the 300-mg dose, in relations to younger sick persons. A higher increase in the incidence was seen in patients who were greater than or equal to 75 years.


Renal Impairment: Safety and efficacy were evaluated in a study that included patients with moderate renal impairment. These patients had less overall glycemic efficacy and a higher occurrence of adverse reactions related to reduced renal-related adverse reactions, decreases in eGFR (estimated glomerular filtration rate) and intravascular volume, as compared to patients with normal renal function or mild renal impairment. Patients treated with 300 mg (higher dose) were more likely to experience increases in potassium. Invokana is not recommended in patients with severe renal impairment or people receiving dialysis or end-stage renal disease.


Hepatic Impairment: Invokana has not been studied in patients with severe hepatic impairment and is not recommended in this population.




Warnings and Precautions


Lower-Limb Amputation: An approximately 2-fold increased risk of lower-limb amputations associated with the use of Invokana was observed in Canagliflozin Cardiovascular Assessment Study (CANVAS), CANVAS renal-end-points trial (CANVAS-R), and two large, randomized, placebo-controlled tests evaluating patients with type 2 diabetes who had either set up cardiovascular disease or were at risk for cardiovascular disease. The danger of lower-limb amputations was observed at both the 100-mg and 300-mg once-daily dosage regimens. 


Amputations of the toe and mid foot (99 out of 140 patients with amputations receiving Invokana in the two tests) were the most recurrent. However, amputations include the leg, above and below the knee, weas also observed (41 out of 140 patients with amputations receiving Invokana in the two tests). Some patients had too many amputations, some implicating both lower limbs.


Lower-limb infections, gangrene and diabetic foot ulcers were the most common, occurring medical events leading to the need for an amputation. The danger of amputation was greatest in patients with a baseline history of prior amputation, neuropathy and peripheral vascular disease.


Before initiating treatment with Invokana, consider factors in the patient history that may predispose to the need for amputations, such as a history of prior amputation, neuropathy, diabetic foot ulcers and peripheral vascular disease. Counsel patients about the importance of routine prohibited foot care. Follow-up sick persons for symptoms and signs of infection (including osteomyelitis), tenderness or knee pain, sores, or ulcers involving the lower limbs, and non-continue if these complications occur. 


Hypotension: Invokana causes intravascular speed contraction. The various symptoms of hypotension has been observed in patients after taking Invokana, especially in sick persons with impaired renal function, older patients, and sick persons on either medications or diuretics that interfere with the patients with low systolic blood pressure or renin-ang patients with low systolic blood pressure (iotensin-aldosterone system). Before initiating in patients with greater than and equal to 1 of these features, volume status should be evaluated and put in order. Monitor for symptoms and signs after taken.


Ketoacidosis: Reports of ketoacidosis, a serious life-threatening situation needing emergent hospitalization, have been singled out in patients with type 1 and 2 diabetes mellitus receiving SGLT2 inhibitors, constituting Invokana. Grievous cases of ketoacidosis have been reported in patients taking Invokana. Before initiating Invokana, consider factors in patient history that may predispose to ketoacidosis, including caloric restriction disorders, pancreatic insulin deficiency, and alcohol setback. Sick persons treated with Invokana, should take into account follow up for temporarily discontinuing and ketoacidosis in clinical situations known to predispose to ketoacidosis (for instance, surgery or prolonged fasting due to acute illness).


Acute Kidney injury and impairment in renal function: Invokana causes intravascular volume contraction and can cause renal impairment. Post marketing incidence of acute kidney problem, some needing dialysis and hospitalization were made official; some reports include sick persons younger than 65 years of age. Before initiation, give attention to factors that may render patients with acute kidney injury constituting chronic hypovolemia, renal insufficiency, concomitant medications and congestive heart failure. Consider temporarily non-continuing Invokana in any setting of fluid losses or reduced oral intake; monitor patients for signs and symptoms of acute kidney injury. If acute kidney injury occurs, institute treatment or non-continue promptly and.


Invokana increases serum creatinine and reduces eGFR. Sick persons with hypovlemia (decrease blood volume) may be more subject to these changes. Renal function abnormality has also been observed in subjects after taking Invokana. Renal function should be assessed in relations to initiation and periodically afterwards. More frequent and dose adjustment, renal function monitoring is recommended in patients with an eGFR less than 60 mL/min/1.73 m2.


Hyperkalemia: Invokana can lead to hyperkalemia. Sick persons with average renal impairments who are taking medications that interfere with institute treatment or potassium excretion or institute treatment that interfere with the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia. Following-up serum potassium degree occasionally in patients with impaired renal function and in patients predisposed to hyperkalemia due to other medical conditions or medications.


Urosepsis and Pyelonephritis: There have been reports of serious urinary tract infections, including pyelonephritis or urosepsis and requiring hospitalization in patients receiving SGLT2 inhibitors, involving Invokana. Therapy with SGLT2 inhibitors increases this danger. Assessed patients for symptoms and signs and treat promptly.


Hypoglycemia with concomitant use within sulin and insulin secretagogues: Invokana can increase the risk of hypoglycemia when combined within insulin secretagogue or sulin. A small dosage of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with Invokana.


Genital Mycotic Infections: Invokana increases risk of genital mycotic diseases. Patients with a history of these diseases and uncircumcised males were more likely to develop these diseases.


Hypersensitivity Reactions: Hypersensitivity reactions, including anaphylaxis and angioedema were reported with Invokana; these reactions generally occurred within hours to days after initiation. If reactions occur, non-continue Invokana, treat per standard of care, and monitor until signs and symptoms resolve.


Bone Fracture: Increased risk of bone fracture, happening as early as twelve weeks after therapy initiation, was noticed in patients taking Invokana. Take into account the factors that contribute to fracture risk prior to initiating Invokana.


Increases in Low-Density Lipoprotein (LDL-C): Dose-related increases in LDL-C can occur with Invokana. Monitor LDL-C and treat per standard of care after initiating.


Macrovascular results: There have not been the experiences of any clinical studies setting up conclusive evidence of macrovascular risk reduction with Invokana.




Indication statement


This indication statement defines concisely what Invokana is. Therefore, in light of this indication statement, Invokana denotes the following:


  • Invokana is a prescribed drug used along with exercise and diet and to lower blood sugar in adults with type 2 diabetes.
  • Invokana is not meant for those with diabetes type 1.
  • Invokana drug is not for patients with diabetic ketoacidosis (increased ketones or urine in the blood).
  • It is not known if Invokana is effective and safe in children under 18 years of age.


As straight and simple as those rules depict, you must have to consider them in relations to using the Invokana drug because they shows serious warnings and precautions. As emphasized in the second point clearly that it is not for those suffering from type 1 diabetes, therefore you have to know that before ever attempting to take Invokana. And since the fourth point expresses uncertainty, it’s better not to give the Invokana drug to a child under 18 years. Failure to adhere to these four indications could land you into terrible side effects associated with the drug.


The medicinal ingredient of Invokana is Canagliflozin. As articulated strictly above that the medicine is not for those suffering with type 1diabetes but rather type 2 diabetes, it should strongly be noted.




Drugs that may interact with Invokana


  • Digoxin, a drug used to cure heart problems.
  • Furosemide or other diuretics (water pills).
  •  An ARB or ACE inhibitor (to lower your blood pressure).
  • A sulfonylurea or insulin o(such as glyburide or gliclazide and glimepiride,)
  • Phenobarbital or phenytoin, and Carbamazepine,
  • Efavirenz or ritonavir.
  • Rifampin.
  • St. John’s wort.




Before taking this medicine


You should not use Invokana if you are allergic to canagliflozin, or if you notice the followings:


  • Severe kidney disease or if you are on dialysis. To make sure Invokana is effective on you, tell your physicians if you have ever had:
  • Kidney disease
  • Liver disease
  • Urination problems or other bladder infections
  • Blood circulation problems
  • Nerve problems caused by diabetes
  • A diabetic foot ulcer or amputation
  • An electrolyte imbalance (such as high levels of potassium in your blood)
  • High cholesterol levels
  • Diabetic ketoacidosis (Get to your physician for therapy with insulin)
  • If you are on a low salt diet; or
  • If you use other oral diabetes medicines or insulin


It is not known whether Invokana will harm an unborn baby. Tell your physician if you plan to become pregnant or are pregnant. It is not known whether canagliflozin passes into breast milk or if it could harm a suckling child. You must ensure you do not breast-feed while using this medicine. Invokana uses do not include people younger than 18 years old.


This article on Invokana only serves as a guide and should never, for whatever reason, be used as a replacement to a doctor’s prescription.


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