The drug Invokana (Canagliflozin) often regarded as the first diabetes type 2 prescriptive to have ever been approved by the Food and Drug Administration (FDA) of the United States of America. However, it is not indicative for the treatment of diabetes type 1.
Through this article you will be able to grasp all the necessary information surrounding the drug Invokana with regards the following domains such as the side effects of Invokana, uses of Invokana, and the dosage of Invokana.
Description of Invokana
Invokana (canagliflozin) is an oral therapeutic medicine that facilitates the control blood sugar levels. This drug enables the kidney eliminates glucose from the bloodstream. Additionally, Invokana is used together with diet and exercise to foster the blood sugar control in adults with diabetes type 2. It should be understood that Invokana is not a prescription for treating diabetes type 1. It is also vital to know that you should nottake Invokana if you have chronic kidney infection (or if you are on dialysis). The anti-diabetic drug (Invokana) makes the body to send out glucose from the blood through urine, and by this it signifies that the energies in the glucose are sent out. This action equally facilitates in strengthening the loss of weight, when the medicine is taken in combination with a balanced diet and constant physical activity.
What is type 2 diabetes?
Type 2 diabetes is a situation in which your body does not make large or normal quantify of 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 accelerate your dose to 300 mg. However, if you have a kidney infection, your doctor may limit your doseto100 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 case of administering the drug above the normal dose (that is overdose), get a health care 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 next dose, skip the missed dose and follow your normal schedule. Do not take a double dose (two doses on the same day) to make up for the missed dose.
This medicine does not need any unique storage conditions. Store at room temperature (15-30°C). Keep this drug 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. You should ensure that drugs are not disposed through household waste and waste water. Consult your pharmacist on how to dispose medicines which are no longer taken. These measures 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 diabetes type 2. The differences uses of Invokana are explained below:
Invokana is made up of an effective substance canagliflozin which is part of a group of drug known as blood glucose lowering drugs. The blood glucose lowering drugs are drugs used by adults to treat diabetes type 2. This medicine works by raising the level of sugar removed from your body in your urine. This decreases the quantity of sugar in your blood.
Invokana can be used alone or along with other medicines to treat type 2 diabetes patients. Such drug combination includes metformin, insulin, a DPP-4 inhibitor such as sitagliptin, saxagliptin or linagliptin, a sulphonylurea such as climepiride 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 than it is important to keep the 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 decrease the proportion of sugar in the blood. It is formulated for used only in the treatment of type 2 diabetes and not effective for diabetes type 1.
Side effects of Invokana
At this point, you will be taken to the common and uncommon side effects of Invokana. A side effect is an unwanted response to a medication when it is administered in usual doses. Side effects can be severe and moderate 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).
- Disruption in urination like frequent urinating or in larger proportion, an urgent need to urinate, and a need to urinate at night
- Feeling thirsty showcases Invokana side effects.
- Blood tests may show changes in cholesterol (blood fat) levels and increases in the amount of red blood cells in your blood.
- Blurred vision
- Tingling lips
- Trembling, sweating, pale looking
- A change in mood, such as feeling anxious or confused
- Unusual sleepiness or tiredness
- A different adorer taste to your urine or sweat
Dehydration portrays uncommon Invokana side effects that may infect up to 1 in 100 people. (Being unable to have the needed water in your body) indicates visible side effects of Invokana. Dehydration happens more often in older persons (aged greater than 75 years), people with kidney issues, and people taking water tablets (diuretics). Ensure you 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, have low blood pressure, feeling thirsty, tired or weak
Effects of overdose with Invokana:
It is not certain what actually to expect from an Invokana overdose. Normally, there have not been any pleasant documented clinical investigations on the overdoses of Invokana. However, due to the fact that its component constitution elements are known and their reactions, it might be good to expect that the following problems in subjects taking this drug.
- Low blood pressure (hypotension)
- (Enlargement,) or high blood potassium levels
- Yeast infections in women or genital fungal infections in uncircumcised men
- Low blood sugar
Before taking this medicine
You should not use Invokana if you are allergic to Canagliflozin, or if you notice the followings:
- for you, tell your physicians if you have ever had:
- Kidney disease
- Urination problems or other bladder infections
- Blood circulation problems
- Liver disease
- Liver disease
- Severe kidney disease or if you are on dialysis. To make sure Invokana is effective
- Nerve problems caused by diabetes
- Liver disease
- If you use other oral diabetes medicines or insulin
- An electrolyte imbalance (such as high levels of potassium in your blood)
- High cholesterol levels
- If you are on a low salt diet
Treatment for an Invokana Overdose
At this time, it is not known how best to treat this type of overdose. If the over dosage was recent, your doctor or health care 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. Treatment may equally comprise 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, particularly 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.
This indication statement tells precisely 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.
These rules as straight and direct as they are, you must have to consider them in view 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 theInvokana drug to a child under 18 years. If you fail to hold on to these four indications you could put yourself into terrible side effects linked with the drug.
The medicinal ingredient of Invokana is Canagliflozin. As expressed strictly above that the medicine is not for those suffering with diabetes type 1 but rather type 2 diabetes, it should strongly be noted.
Drugs that may interact with Invokana
- An ARB or ACE inhibitor (to lower your blood pressure)
- Digoxin, a drug used to cure heart problems
- Furosemide or other diuretics (water pills)
- Phenobarbital or phenytoin, and Carbamazepine
- Efavirenz or ritonavir
- A sulfonylurea or insulin o(such as glyburide or cliclazide and climepiride,)
- St. John’s wort
Uses in specific populations (Invokana)
Pregnancy: Based on animal data indicating adverse renal effects, Invokana is not considered within the second and last three months of pregnancy. Insufficient data with Invokanain pregnant women are not adequate to assess a drug-associated danger for major miscarriage or birth defects. There are risks to the mother and fetus linked with poorly managed diabetes in pregnancy. In animal researches, adverse renal pelvic and tubule dilatations that were not reversible were noticed in rats when canagliflozin was administered during a period of renal development corresponding to the late second and third trimesters of human pregnancy, at an exposure 0.5-time the 300 mg clinical dose, based on AUC. The assessed background danger of major birth defects is 6–10% in women with pre-gestational diabetes with an HbA1C >7 and has been reported to be as great as 20–25% in women with an HbA1C >10. The assessed background danger of miscarriage for the indicated population is not known. In the American overall population, the assessed background danger of large birth defects and miscarriage in clinically acknowledged pregnancies is 2–4% and 15–20%, respectively.
Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, stillbirth and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macroscopic associated morbidity.
Nursing mothers: There exists no information as concerns 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 intense adverse reactions in a breastfed infant, women were advised 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 far higher than and equal to 65 years and 345 patients far higher than and equal to 75 years were exposed to Invokana in 9 clinical researches. Patients greater than and equal to 65 years had a higher events of adverse reactions associated to reduced intra vascular speed (for examples hypertension, 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 intra vascular 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: It should be known that Invokana has known no study in patients with chronic hepatic impairment and is not approved in this population.
Warnings and Precautions
Lower-Limb Amputation: An approximately 2-fold additional risk of lower-limb amputations linked with the use of Invokana was noticed in Canagliflozin Cardio vascular 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 a 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.
Situations of amputations of the mid footas well as toe (that is, 99 out of 140 patients with amputations taking Invokana in the two tests) were the most recurrent. Considerably, amputations include the leg, above and below the knee we have 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 as well as peripheral vascular disease. Patients should be advised about the importance of routine prohibited foot care. Patients should be monitored 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: What should be known is that Invokana causes intra vascular speed contraction. The different symptoms of hypotension have been noticed in patients after taking Invokana, particularly in patients 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 running on 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 taking Invokana, certain factors should be taken into account in patient history that may predispose to ketoacidosis, alongside caloric restriction disorders, pancreatic insulin deficiency, and alcohol setback. Patients treated with Invokana, should take into account, follow up for temporarily discontinuing as well as ketoacidosis in clinical casess 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 intra vascular 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. 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: A lot of reports have existed for serious urinary tract infections, alongside pyelonephritis or urosepsis and needing hospitalization in patients taking SGLT2 inhibitors, involving Invokana. Treatment with SGLT2 inhibitors raises 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 secretagogues or sulin. A small dosage of insulin or insulin secretagogues may be required to minimize the risk of hypoglycemia when used in combination with Invokana.
Genital Mycotic Infections: Invokana elevates the risk of genital mycotic diseases. Patients with a history of these diseases and uncircumcised males were more subject to contract these diseases.
Hypersensitivity Reactions: There are hypersensitivity reactions, couple with anaphylaxis and angioedema were reported with Invokana; these reactions generally happened within hours to days after initiation. If reactions happen, discontinue Invokana, treat per standard of care, and monitor until signs and symptoms resolve.
Bone Fracture: Happenings of higher risk of bone fracture, occurring 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.
Noticing elevations in Low-Density Lipoprotein (LDL-C): Dose-associated elevations in LDL-C can happen with Invokana. Monitor LDL-C and treat per standard of care after initiating.
Macro vascular results: What is noteworthy here is that there have not been the experiences of any clinical researches setting up conclusive prove of macro vascular risk reduction with Invokana.
A Disclaimer: The information in this article plays the role of a guide and should in no context replace the doctor’s prescriptions.