Invokana is a brand-name prescription drug. It’s FDA-approved for use in adults with type 2 diabetes to:

  • Improve blood sugar levels. For this use, Invokana is prescribed in addition to diet and exercise to lower blood sugar levels.
  • Reduce the risk of certain cardiovascular problems. For this use, Invokana is given to adults with known cardiovascular disease. It’s used to lower the risk of heart attack and stroke that don’t lead to death. And the drug is used to reduce the risk of death from a heart or blood vessel problem.
  • Reduce the risk of certain complications in people who have diabetic nephropathy with albuminuria. For this use, Invokana is given to certain adults who have diabetic nephropathy (kidney damage that’s caused by diabetes) with albuminuria* of greater than 300 milligrams per day. It’s used to lower the risk of:
    • death caused by a heart or blood vessel problem

For more information about these uses of Invokana and certain limitations of its use, see the “Invokana uses” section below.

* With albuminuria, you have high levels of a protein called albumin in your urine.

Drug details

Invokana contains the drug canagliflozin. It belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT-2) inhibitors. (A drug class describes a group of medications that work in the same way.)

Invokana comes as a tablet that’s taken by mouth. It’s available in two strengths: 100 mg and 300 mg.

Effectiveness

For information on Invokana’s effectiveness for its approved uses, see the “Invokana uses” section below.

Invokana contains one active drug ingredient: canagliflozin. It’s available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Invokana can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Invokana. This list doesn’t include all possible side effects.

To learn more about possible side effects of Invokana or how to manage them, talk with your doctor or pharmacist.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Invokana, you can do so through MedWatch.

More common side effects

The more common side effects of Invokana can include*:

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

You should also call your doctor if you think you have a urinary tract infection or yeast infection.

* This is a partial list of more common side effects from Invokana. To learn about other mild side effects, talk with your doctor or pharmacist or visit Invokana’s medication guide.
† For more information about this side effect, see the “Side effect details” section just below.

Serious side effects

Serious side effects from Invokana aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

* For more information about this side effect, see the “Side effect details” section just below.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Invokana. In clinical studies, up to 4.2% of people taking Invokana reported having mild allergic reactions.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Only a few people in clinical studies reported severe allergic reactions while taking Invokana.

Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Invokana. But call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Amputation

Invokana may increase your risk of amputation of lower limbs. (With amputation, one of your limbs is removed.)

Two studies found an increased risk for lower limb amputation in people who took Invokana and had:

In the studies, up to 3.5% of the people who took Invokana had an amputation. Compared with people who didn’t take the drug, Invokana doubled the risk of amputation. The toe and the midfoot (arch area) were the most common areas of amputation. Some leg amputations were also reported.

Before you start taking Invokana, talk with your doctor about your risk of amputation. This is especially important if you’ve had an amputation in the past. It’s also important if you have a blood circulation or nerve disorder, or diabetic foot ulcers.

Call your doctor right away and stop taking Invokana if you:

  • feel new foot pain or tenderness
  • have foot sores or ulcers
  • get a foot infection

Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. If you develop symptoms or conditions that increase your risk for lower limb amputation, your doctor may have you stop taking Invokana.

Yeast infection

Taking Invokana increases your risk for a yeast infection. This is true for both men and women, according to data from clinical trials. In the trials, up to 11.6% of the women and 4.2% of the men had a yeast infection.

You’re more likely to develop a yeast infection if you’ve had one in the past or if you’re an uncircumcised male.

If you get a yeast infection while taking Invokana, talk with your doctor. They can suggest ways to treat it.

Diabetic ketoacidosis

Although it’s rare, some people who take Invokana can develop a serious condition called diabetic ketoacidosis. This condition occurs when cells in your body don’t get the glucose (sugar) they need for energy. Without this sugar, your body uses fat for energy. And this can lead to high levels of acidic chemicals called ketones in your blood.

Symptoms of diabetic ketoacidosis can include:

  • excessive thirst
  • urinating more often than normal
  • nausea
  • vomiting
  • stomach pain
  • tiredness
  • weakness
  • shortness of breath
  • breath that smells fruity
  • confusion

In severe cases, diabetic ketoacidosis can cause coma or death. If you think you may have diabetic ketoacidosis, call your doctor right away. But if your symptoms are severe, call 911 or go to the nearest emergency room.

Before you start taking Invokana, your doctor will assess your risk for developing diabetic ketoacidosis. If you have an increased risk of this condition, your doctor may monitor you closely during treatment. And in some cases, such as if you’re having surgery, they may have you temporarily stop taking Invokana.

Fournier’s gangrene

Fournier’s gangrene is a rare infection in the area between your genitals and rectum. Symptoms can include:

  • pain, tenderness, swelling, or reddening in your genital or rectal area
  • fever
  • malaise (overall feeling of discomfort)

People in clinical trials of Invokana didn’t get Fournier’s gangrene. But after the drug was approved for use, some people reported having Fournier’s gangrene while taking Invokana or other drugs in the same drug class. (A class of drugs describes a group of medications that work in the same way.)

More serious cases of Fournier’s gangrene have led to hospitalization, multiple surgeries, or even death.

If you think you may have developed Fournier’s gangrene, call your doctor right away. They may want you to stop taking Invokana. They will also recommend treatment for the infection.

Kidney damage

Taking Invokana can increase your risk of kidney damage. Symptoms of kidney damage can include:

  • urinating less often than normal
  • swelling in your legs, ankles, or feet
  • confusion
  • fatigue (lack of energy)
  • nausea
  • chest pain or pressure
  • irregular heartbeat
  • seizures

After the drug was approved for use, some people taking Invokana reported that their kidneys worked poorly. When these people stopped taking Invokana, their kidneys began to work normally again.

You’re more likely to have kidney problems if you:

  • are dehydrated (have a low fluid level)
  • have kidney or heart problems
  • take other medications that affect your kidneys
  • are older than age 65

Before you start taking Invokana, your doctor will test how well your kidneys are working. If you have kidney problems, you may not be able to take Invokana.

Your doctor may also test how your kidneys are working during your treatment with Invokana. If they detect any kidney problems, they may change your dose or stop your treatment with the drug.

Bone fractures

In a clinical study, some people who took Invokana experienced bone fracture (a broken bone). The fractures weren’t usually severe.

Symptoms of bone fracture can include:

  • pain
  • swelling
  • tenderness
  • bruising
  • deformity

If you’re at high risk for a fracture or if you’re concerned about breaking a bone, talk with your doctor. They can suggest ways to help prevent this side effect.

Falls

In nine clinical trials, up to 2.1% of people who took Invokana had a fall. There was a higher risk of falls in the first few weeks of treatment.

If you have a fall while taking Invokana or if you’re concerned about falling, talk with your doctor. They can suggest ways to help prevent this side effect.

Pancreatitis (not a side effect)

Pancreatitis (inflammation in your pancreas) was extremely rare in clinical trials. Rates of pancreatitis were similar between people who took Invokana and those who took a placebo (treatment without active drug). Because of these similar results, it’s not likely that Invokana caused the pancreatitis.

If you have concerns about developing pancreatitis with Invokana, talk with your doctor.

Joint pain (not a side effect)

Joint pain wasn’t a side effect of Invokana in any clinical trials.

However, some other diabetes drugs may cause joint pain. In fact, the Food and Drug Administration (FDA) released a safety announcement for a class of diabetes drug called dipeptidyl peptidase-4 (DPP-4) inhibitors. (A drug class describes a group of medications that work in the same way.) The announcement said that DPP-4 inhibitors may cause severe joint pain.

But Invokana doesn’t belong to that drug class. Instead, it belongs to a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors.

If you have concerns about joint pain with Invokana use, talk with your doctor.

Hair loss (not a side effect)

Hair loss wasn’t a side effect of Invokana in any clinical trials.

If you’re concerned about hair loss, talk with your doctor. They can help you determine what’s causing it and ways to treat it.

The Invokana dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Invokana to treat
  • your age
  • other medical conditions you may have
  • how well your kidneys are working
  • certain other medications you may be taking with Invokana

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Invokana comes as a tablet. It’s available in two strengths:

  • 100 milligrams (mg), which comes as a yellow tablet
  • 300 mg, which comes as a white tablet

Dosage for lowering blood sugar levels

Recommended dosages of Invokana to lower blood sugar levels are based on a measurement called estimated glomerular filtration rate (eGFR). This measurement is done using a blood test. And it shows how well your kidneys are working.

In people with an:

  • eGFR of at least 60, they have no loss of kidney function to mild loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily. Their doctor may increase their dosage to 300 mg once daily if needed to help manage their blood sugar level.
  • eGFR of 30 to less than 60, they have mild-to-moderate loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily.
  • eGFR of less than 30, they have severe loss of kidney function. It’s not recommended that they begin using Invokana. But if they’ve already been using the drug and are passing a certain level of albumin (a protein) in their urine, they may be able to continue taking Invokana.*

Note: Invokana shouldn’t be used by people who are using dialysis therapy. (Dialysis is a procedure that’s used to clear waste products from your blood when your kidneys aren’t healthy enough to do so.)

* For this use, people would be taking Invokana at a dosage of 100 mg to lower the risk of certain complications of diabetic nephropathy. See the “Invokana uses” section for more information.

Dosage for reducing cardiovascular risks

Recommended dosages of Invokana to reduce cardiovascular risks are the same as they are to lower blood sugar levels. See the section above for details.

Dosage for reducing the risk of complications from diabetic nephropathy

Recommended dosages of Invokana to lower the risks of complications from diabetic nephropathy are the same as they are to lower blood sugar levels. See the section above for details.

What if I miss a dose?

If you miss a dose of Invokana, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose at the normal time. Don’t try to catch up by taking two doses at once. This can cause dangerous side effects.

Using a reminder tool can help you remember to take Invokana every day.

Be sure to take Invokana only as your doctor prescribes.

Will I need to use this drug long term?

If you and your doctor agree that Invokana is working well for you, you’ll likely use it long term.

There are other drugs available that can treat your condition. Some may be better suited for you than others. If you’re interested in finding an alternative to Invokana, talk with your doctor about other medications that may work well for you.

Alternatives for lowering blood sugar levels in people with type 2 diabetes

Examples of other drugs that may be used to lower blood sugar levels in people with type 2 diabetes include:

  • sodium-glucose co-transporter 2 (SGLT-2) inhibitors, such as:
    • ertugliflozin (Steglatro)
  • incretin mimetics/glucagon-like peptide-1 (GLP-1) receptor agonists, such as:
    • dulaglutide (Trulicity)
    • liraglutide (Victoza)
    • lixisenatide (Adlyxin)
    • albiglutide (Tanzeum)
  • metformin (Glucophage, Glumetza, Riomet)
  • dipeptidyl peptidase-4 (DPP-4) inhibitors, such as:
    • alogliptin (Nesina)
    • linagliptin (Tradjenta)
    • saxagliptin (Onglyza)
  • thiazolidinediones, such as:
    • pioglitazone (Actos)
    • rosiglitazone (Avandia)
  • alpha-glucosidase inhibitors, such as:
    • miglitol (Glyset)
  • sulfonylureas, such as:
    • chlorpropamide

Alternatives for reducing the risk of cardiovascular problems in people with type 2 diabetes

Examples of other drugs that may be used to reduce the risk of certain cardiovascular problems* in people with type 2 diabetes include:

  • other SGLT2 inhibitors, such as empagliflozin (Jardiance)
  • glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide (Victoza)
  • statin drugs, such as:
    • atorvastatin (Lipitor)
    • rosuvastatin (Crestor)

* For this use, Invokana is given to lower the risk of certain types of heart attack and stroke and the risk of death from a heart or blood vessel problem.

Alternatives for reducing the risk of complications from diabetic nephropathy in people with type 2 diabetes

Examples of other drugs that may be used to reduce the risk of complications* of diabetic nephropathy† in people with type 2 diabetes include:

* For this use, Invokana is given to lower the risk of end stage kidney disease, death caused by a heart or blood vessel problem, doubled blood level of creatinine, and the need to be hospitalized for heart failure.
† Diabetic nephropathy is kidney damage that’s caused by diabetes.

You may wonder how Invokana compares to other medications that are prescribed for people with type 2 diabetes. Below are comparisons between Invokana and certain medications.

Invokana vs. Jardiance

Invokana and Jardiance (empagliflozin) are both in the same class of medications: sodium-glucose co-transporter 2 (SGLT-2) inhibitors. This means that they work in the same way to treat type 2 diabetes.

Invokana contains the drug canagliflozin. Jardiance contains the drug empagliflozin.

Uses

Both Invokana and Jardiance are approved by the Food and Drug Administration (FDA) to:

In addition, Invokana is approved for reducing the risk of:

  • Heart attack and stroke that don’t lead to death in adults with type 2 diabetes and heart disease.
  • Certain complications of diabetic nephropathy in adults with type 2 diabetes. (With diabetic nephropathy, you have kidney damage that’s caused by diabetes.)

For more information on Invokana’s approved uses and its limitations of use, see the “Invokana uses” section above.

Drug forms and administration

Both Invokana and Jardiance come as tablets that you take by mouth in the morning.

You can take both drugs with or without food, but it’s best to take Invokana before breakfast.

Side effects and risks

Invokana and Jardiance are from the same drug class and act in similar ways within the body. Because of this, they cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Invokana, with Jardiance, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Invokana, with Jardiance, or with both drugs (when taken individually).

* Both Invokana and Jardiance can cause kidney damage. In an analysis of studies, people who took Invokana had a higher risk for kidney damage than those who took Jardiance.

Effectiveness

These drugs haven’t been compared head-to-head in clinical studies. But studies have found both Invokana and Jardiance to be effective for their approved uses.

Costs

Invokana and Jardiance are both brand-name drugs. They don’t have generic forms. Brand-name medications usually cost more than generics.

According to estimates from GoodRx.com, Invokana and Jardiance generally cost about the same. The actual price you would pay for either drug would depend on your insurance plan, your location, and the pharmacy you use.

Invokana vs. Farxiga

Invokana and Farxiga are in the same class of medications: sodium-glucose co-transporter 2 (SGLT-2) inhibitors. This means that they work in the same way to treat type 2 diabetes.

Invokana contains the drug canagliflozin. Farxiga contains the drug dapagliflozin.

Uses

Both Invokana and Farxiga are approved by the Food and Drug Administration (FDA) to improve blood sugar levels in adults with type 2 diabetes.

Invokana is also approved to reduce the risk of:

  • heart attack and stroke that don’t lead to death in people with both type 2 diabetes and heart disease
  • cardiovascular death in people with both type 2 diabetes and heart disease
  • certain complications of diabetic nephropathy* in people with type 2 diabetes

Farxiga is also approved to reduce the risk of:

  • hospitalization for heart failure in people with type 2 diabetes and either heart disease or risk factors for heart disease
  • cardiovascular death and hospitalization for heart failure in adults with a certain type of heart failure with reduced ejection fraction

For more information on Invokana’s approved uses and its limitations of use, see the “Invokana uses” section above.

* With diabetic nephropathy, you have kidney damage that’s caused by diabetes.

Drug forms and administration

Both Invokana and Farxiga come as tablets that you take by mouth in the morning. You can take both drugs with or without food, but it’s best to take Invokana before breakfast.

Side effects and risks

Invokana and Farxiga are from the same drug class and act in similar ways within the body. Because of this, they cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Invokana, with Farxiga, or with both drugs (when taken individually).

  • Can occur with Invokana:
    • thirst
  • Can occur with Farxiga:
    • respiratory infections such as the common cold or the flu
    • back pain or limb pain
    • discomfort while urinating
  • Can occur with both Invokana and Farxiga:

Serious side effects

These lists contain examples of serious side effects that can occur with Invokana, with Farxiga, or with both drugs (when taken individually).

* Both Invokana and Farxiga can cause kidney damage. But in an analysis of studies, people who took Invokana had a lower risk for kidney damage than those who took Farxiga.

Effectiveness

These drugs haven’t been compared head-to-head in clinical studies. But studies have found both Invokana and Farxiga to be effective for their approved uses.

Costs

Invokana and Farxiga are both brand-name drugs. They don’t have generic forms. Brand-name medications usually cost more than generics.

According to estimates from GoodRx.com, Invokana and Farxiga generally cost about the same. The actual price you would pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

As with all medications, the cost of Invokana can vary. To find current prices for Invokana in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance coverage and the pharmacy you use.

Financial and insurance assistance

If you need financial support to pay for Invokana, help is available.

Janssen Pharmaceuticals, Inc., the manufacturer of Invokana, offers a program called Janssen CarePath Savings Program. For more information and to find out if you’re eligible for support, call 877-468-6526 or visit the program website.

The Food and Drug Administration (FDA) approves prescription drugs such as Invokana to treat certain conditions.

Invokana in people with type 2 diabetes

Invokana is FDA-approved for use in adults with type 2 diabetes to:

  • Improve blood sugar levels. For this use, Invokana is prescribed in addition to diet and exercise to lower blood sugar levels.
  • Reduce the risk of certain cardiovascular problems. For this use, Invokana is given to adults with known cardiovascular disease. It’s used to lower the risk of heart attack and stroke that don’t lead to death. And the drug is used to reduce the risk of death from a heart or blood vessel problem.
  • Reduce the risk of certain complications in people with diabetic nephropathy. For this use, Invokana is given to certain adults with diabetic nephropathy (kidney damage that’s caused by diabetes) with albuminuria* of greater than 300 milligrams per day. It’s used to lower the risk of:
    • death caused by a heart or blood vessel problem

Normally, a hormone called insulin moves sugar from your blood into your cells. And your cells use that sugar for energy. But with type 2 diabetes, your body doesn’t react to insulin properly.

Over time, your body may even stop making enough insulin. So, with type 2 diabetes, sugar isn’t being moved out of your blood like usual. And this leads to increased blood sugar levels.

Having increased blood sugar levels can damage your blood vessels, and it may even cause problems with your heart and kidneys.

Invokana works to lower your blood sugar levels and reduce the risk of certain problems with your blood vessels, heart, and kidneys.

* With albuminuria, you have high levels of a protein called albumin in your urine.

Limitations of use

It’s important to note that Invokana isn’t approved for use in people with type 1 diabetes. Instead, it’s only approved for use in people with type 2 diabetes. It’s thought that people with type 1 diabetes may have an increased risk for diabetic ketoacidosis if they use Invokana. (With diabetic ketoacidosis, you have increased levels of ketones in your blood or urine.) To learn more about this condition, see the “Invokana side effects” section above.

In addition, Invokana shouldn’t be used to help lower blood sugar levels in people with type 2 diabetes who also have severely impaired kidney function. Specifically, the drug shouldn’t be used in those with an estimated glomerular filtration rate (eGFR) of less than 30. (eGFR is a measurement that’s done using a blood test. It shows how well your kidneys are working.) It’s thought that Invokana may not be effective for use in people with this condition.

Effectiveness

Invokana has been studied alone and in combination with other drugs in lowering blood sugar levels in people with type 2 diabetes. In these studies, Invokana was found to lower people’s hemoglobin A1c (HbA1c) level, which is a measurement of average blood sugar levels.

Invokana has also been studied in lowering the risk of certain cardiovascular problems in people with type 2 diabetes. In these studies, the drug lowered rates of certain types of heart attack and stroke and death due to a heart or blood vessel problem.

Also, Invokana was studied in people with diabetic nephropathy as a treatment to lower the risk of certain complications. In this study, people taking Invokana had decreased rates of end stage kidney disease, doubled creatinine level in their blood, and other issues.

For more information on the effectiveness of Invokana for its approved uses, see the drug’s prescribing information.

In addition, guidelines from the American Diabetes Association recommend:

  • using an SGLT2 inhibitor, such as Invokana, as part of the medication regimen for controlling blood sugar in adults with type 2 diabetes who also have heart or kidney disease
  • using an SGLT2 inhibitor in people with type 2 diabetes who have risk factors for cardiovascular problems

Off-label use for Invokana

In addition to use for type 2 diabetes, Invokana may be used off-label for another purpose. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved.

Invokana for type 1 diabetes

Although the manufacturer recommends that Invokana not be used for type 1 diabetes, the drug is still sometimes used off-label to treat the condition.

In one clinical study, people with type 1 diabetes took Invokana and insulin. For the people in the study, this treatment reduced:

If you have questions about treatment options for type 1 diabetes, talk with your doctor.

While Invokana isn’t approved as a weight loss medication, weight loss is a side effect of the drug.

In clinical studies, people who took Invokana lost up to 9 pounds over 26 weeks of treatment. Because of this side effect, your doctor may want you to take Invokana if you have type 2 diabetes and are overweight.

Invokana causes weight loss by sending extra glucose (sugar) from your blood into your urine. The calories from the glucose leave your body in your urine, which may lead to you to lose weight.

Be sure to take Invokana only as your doctor prescribes. Don’t take the drug to lose weight or for any other reason without first talking with your doctor.

Avoid drinking too much alcohol while taking Invokana. Alcohol can change your blood sugar level and increase your risk for:

If you drink alcohol, talk with your doctor about how much alcohol is safe for you while you take Invokana.

Invokana can interact with several other medications. It can also interact with certain supplements and foods.

Different interactions can cause different effects. For instance, some interactions can affect how well a drug works, while others can cause increased side effects.

Invokana and other medications

Below are lists of medications that can interact with Invokana. These lists don’t contain all the drugs that may interact with Invokana.

Before taking Invokana, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Invokana and drugs that can increase the risk of hypoglycemia

Taking Invokana with certain medications can increase your risk for hypoglycemia (low blood sugar level). If you take these medications, you may need to check your blood sugar level more often. Also, your doctor may need to change the dosage of your medications.

Examples of these medications include:

Invokana and drugs that can increase blood sugar levels

Some medications can increase the blood sugar level in your body. If you take these medications, you may need to check your blood sugar level more often. This may help prevent hyperglycemia (high blood sugar level). Also, your doctor may need to change your dosages.

Examples of these medications include:

Invokana and drugs that can lower blood pressure

Taking Invokana with certain medications that decrease blood pressure may cause your blood pressure to become too low. It may also increase your risk for kidney damage.

Examples of these medications include:

  • benazepril (Lotensin)
  • candesartan (Atacand)
  • enalapril (Vasotec)
  • irbesartan (Avapro)
  • lisinopril (Zestril)
  • losartan (Cozaar)
  • olmesartan (Benicar)
  • valsartan (Diovan)

Invokana and drugs that can increase or decrease the effects of Invokana

Some medications can affect how Invokana works in your body. If you take these medications, you may need to check your blood sugar level more often. Also, your doctor may need to change your dosages.

Examples of these medications include:

  • rifampin (Rifadin, Rimactane)
  • phenytoin (Dilantin)
  • phenobarbital
  • ritonavir (Norvir)
  • digoxin (Lanoxin)

Invokana and herbs and supplements

Taking certain herbs and supplements with Invokana may increase your risk for hypoglycemia (low blood sugar level). Examples of these include:

Invokana is approved for certain uses in people with type 2 diabetes. (To learn more about these approved uses, see the “Invokana uses” section above.)

Sometimes, Invokana may be used with other drugs to lower blood sugar levels. Below, we describe this possible situation.

Invokana with other drugs to lower blood sugar levels

Doctors may prescribe Invokana alone or with other drugs to improve blood sugar levels in people with type 2 diabetes.

In diabetes treatment, sometimes one drug alone doesn’t improve blood sugar levels enough. In these cases, it’s typical for people to take more than one medication to control their blood sugar levels.

Invokana and Victoza

Invokana and Victoza both treat type 2 diabetes, but they work in different ways. The two drugs belong to separate drug classes. Invokana is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor. Victoza is a glucagon-like peptide-1 (GLP-1) receptor agonist.

Doctors may prescribe certain SGLT-2 inhibitors and GLP-1 receptor agonists together. This combination may help lower blood sugar levels and decrease the risk of heart-disease related death.

Other GLP-1 receptor agonists include:

  • dulaglutide (Trulicity)
  • exenatide (Bydureon, Byetta)
  • liraglutide (Victoza)
  • lixisenatide (Adlyxin)
  • semaglutide (Ozempic)

Invokana and other diabetes drugs

Examples of other diabetes drugs that can be used with Invokana include:

Invokana and metformin are available as a single combination drug called Invokamet or Invokamet XR. Invokana is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor. Metformin is a biguanide.

Invokamet and Invokamet XR are approved to improve blood sugar levels in adults with type 2 diabetes. Doctors prescribe these drugs in addition to diet and exercise.

Take Invokana as your doctor or healthcare provider recommends.

When to take

It’s best to take Invokana in the morning, before breakfast.

Taking Invokana with food

You can take Invokana with or without food, but it’s best to take it before breakfast. This helps you avoid blood sugar spikes after meals.

Can Invokana be crushed?

No. It’s best to take Invokana whole.

Invokana is approved for certain uses in adults with type 2 diabetes. (For information about these approved uses, see the “Invokana uses” section above.)

What happens with diabetes?

Normally, a hormone called insulin moves sugar from your blood into your cells. And your cells use that sugar for energy. But with type 2 diabetes, your body doesn’t react to insulin properly.

Over time, your body may even stop making enough insulin. So, with type 2 diabetes, sugar isn’t being moved out of your blood like usual. And this leads to increased blood sugar levels.

Having increased blood sugar levels can damage your blood vessels, and it may even cause problems with your heart and kidneys.

What Invokana does

Invokana works by lowering the amount of glucose in your blood. As a sodium-glucose co-transporter 2 (SGLT2), Invokana prevents sugar from being absorbed back into the body. Instead, Invokana helps sugar leave your body through your urine.

By doing this, Invokana also helps to reduce the risk of certain problems with your blood vessels, heart, and kidneys.

How long does it take to work?

Invokana starts to work right after you take it. But it’s at its most effective in lowering your blood sugar level about 1 to 2 hours after you take the drug.

There haven’t been enough studies in humans to know if Invokana is safe to use during pregnancy. Results of animal studies showed a possible risk of kidney problems in fetuses when pregnant females were given the drug.

Because of these studies, Invokana shouldn’t be used during the second and third trimesters of pregnancy. However, keep in mind that animal studies don’t always predict what will happen in people.

If you’re pregnant or planning to become pregnant, talk with your doctor. Together you can weigh the potential risks and benefits of taking Invokana while pregnant.

It isn’t known if Invokana passes into human breast milk. However, it’s best to wait until after you’ve finished breastfeeding before you take Invokana.

Animal studies have shown that the drug does pass into the breast milk of lactating female rats. Keep in mind that animal studies don’t always predict what will happen in people. But because Invokana could possibly affect kidney development in a child who’s breastfed, you shouldn’t take it while you’re breastfeeding.

If you’re planning to breastfeed, talk with your doctor. Together you can decide whether you should take Invokana or breastfeed.

Here are answers to some frequently asked questions about Invokana.

What’s the difference between Invokana and Invokamet?

Invokana contains the drug canagliflozin, which is a sodium-glucose co-transporter 2 inhibitor. Invokana is used with diet and exercise to improve blood sugar levels in adults with type 2 diabetes. It’s also used to reduce the risk of heart attack, stroke, and death in adults with type 2 diabetes and heart disease. In addition, it’s used to reduce the risk of certain complications of diabetic nephropathy (kidney damage that’s caused by diabetes).

Invokamet contains two drugs: canagliflozin (the drug in Invokana) and metformin, a biguanide. Like Invokana, Invokamet is used with diet and exercise to improve blood sugar levels in adults with type 2 diabetes. However, it’s not approved to reduce the risk of heart-related problems such as heart attack or stroke in people with type 2 diabetes and heart disease.

How do I know if Invokana is working?

While taking Invokana, check your blood sugar level regularly to make sure it’s within the goals you and your doctor have set. Together you can track your treatment progress with these checks and with other blood tests, including hemoglobin A1C (HbA1C) levels. The results can show how Invokana and any other diabetes drugs you take are working to lower your blood sugar levels.

Can Invokana help me lose weight?

Yes, it can. Although Invokana isn’t approved as a weight loss medication, study results have shown that losing weight is a possible side effect.

However, be sure to take Invokana only as your doctor prescribes. Don’t take the drug to lose weight or for any other reason without first talking with your doctor.

Has Invokana caused amputations?

Yes, in extreme cases, amputations have occurred. In two studies, up to 3.5% of the people who took Invokana had an amputation. Compared to people who didn’t get the drug, Invokana doubled the risk of amputation. The toe and the midfoot (arch area) were the most common areas of amputation. Some leg amputations were also reported.

If you’re concerned about this side effect or have questions about Invokana, talk with your doctor.

If I stop taking Invokana, will I have withdrawal symptoms?

Stopping Invokana does not cause withdrawal symptoms. However, it can cause your blood sugar levels to increase, which can make your diabetes symptoms worse.

Don’t stop taking Invokana without talking with your doctor first. And if you both decide you should stop taking Invokana and you then have symptoms that concern you, be sure to tell your doctor. They can assess what’s causing them and help you relieve or manage them.

Before taking Invokana, talk with your doctor about your health history. Invokana may not be right for you if you have certain medical conditions. These include:

  • Risk factors for lower limb amputation. Taking Invokana increases the risk of amputation of a lower limb. This risk is increased if you’ve had an amputation in the past or you have heart disease or are at risk for heart disease. The risk is also increased if you have peripheral vascular disease, neuropathy, or foot ulcers caused by diabetes. Before taking Invokana, tell your doctor if you have any of these conditions.
  • Kidney disease. If you have kidney disease, taking Invokana may worsen your condition. If this happens, you may need to stop taking Invokana. Don’t take this medication if you have severe kidney disease.
  • Kidney cancer. In one clinical study, some people taking Invokana developed kidney cancer. But there isn’t enough information to know if this drug is the cause. It also isn’t known if Invokana affects existing kidney cancer. Until more is known, don’t take Invokana if you have kidney cancer.

Note: For information about the potential negative effects of Invokana, see the “Invokana side effects” section above.

Taking too much of this medication can increase your risk for serious side effects.

Overdose symptoms

There is very little information about the symptoms you might have if you take too much Invokana. Symptoms of an overdose might include:

  • severe hypoglycemia (severe low blood sugar level), which can cause shakiness, anxiety, and confusion
  • gastrointestinal problems, which can cause diarrhea, nausea, and vomiting
  • kidney damage

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Invokana from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date they dispensed the medication.

These expiration dates help guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications.

How long a medication remains good can depend on many factors, including how and where you store it.

Be sure to store your Invokana pills at room temperature around 77°F (25°C) in a tightly sealed container.

If you have unused medication that has gone past the expiration date, ask your pharmacist whether you might still be able to use it.

The following information is provided for clinicians and other healthcare professionals.

Indications

Invokana is FDA-approved for use in adults with type 2 diabetes mellitus to:

  • Improve blood glucose levels, in conjunction with diet and exercise.
  • Lower the risk of major cardiovascular problems, in people with known cardiovascular disease. Specifically, the drug lowers the risk of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
  • Reduce the risk of certain complications of diabetic nephropathy in people with albuminuria. Specifically, the drug lowers the risk of doubled creatinine in the blood, end-stage renal disease, hospitalization due to heart failure, cardiovascular death.

Mechanism of action

Invokana blocks sodium-glucose co-transporter 2 (SGLT-2) in the proximal renal tubules. This prevents reabsorption of filtered glucose from the renal tubules. The result is osmotic diuresis due to excess excretion of urinary glucose.

Pharmacokinetics and metabolism

After oral administration, maximum concentration occurs within 1 to 2 hours. Invokana can be taken with or without food. Taking Invokana with a meal containing high-fat content does not have any effect on the drug’s pharmacokinetics. However, taking Invokana before a meal may reduce postprandial glucose changes due to delayed glucose absorption in the intestines. Because of this, Invokana should be taken prior to the first meal of the day.

The oral bioavailability of Invokana is 65%.

Invokana is primarily metabolized by O-glucuronidation via UGT1A9 and UGT2B4. Metabolism via CYP3A4 is considered a minor pathway.

The half-life of Invokana is about 10.6 hours for the 100-mg dose. The half-life is about 3.1 hours for the 300-mg dose.

Renal dosing

For patients with an eGFR less than 60 mL/min/1.73 m2, adjust the Invokana dose. Monitor their renal function more often.

Contraindications

Invokana is contraindicated in people who:

  • have a serious hypersensitivity reaction to Invokana
  • are on dialysis therapy

Storage

Invokana should be stored at 77°F (25°C).

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and isn’t intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.