Invokana is a brand-name prescription medication. It's used to improve blood sugar levels in adults with type 2 diabetes. Doctors prescribe Invokana in addition to diet and exercise.

Invokana contains the drug canagliflozin. This medication belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT-2) inhibitors.

Study results have shown that Invokana reduced the risk of heart attack, stroke, and death in adults with type 2 diabetes and heart disease by 14 percent.

Invokana comes as a tablet you take by mouth. It's available in two strengths: 100 mg (a yellow tablet) and 300 mg (a white tablet).

Invokana is available only as a brand-name medication. It's not currently available in generic form.

Invokana contains one active drug ingredient: canagliflozin. This medication is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor.

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.

More common side effects

The more common side effects of Invokana can include:

  • urinary tract infections
  • urinating more often than normal
  • thirstiness
  • constipation
  • nausea
  • yeast infections in men and women
  • vaginal itching

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.

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.

For more detailed information on serious side effects, see "Side effect details" below. Serious side effects and their symptoms can include the following:

  • Dehydration, which can cause low blood pressure. Symptoms can include:
    • dizziness
    • feeling faint
    • lightheadedness
    • weakness, especially when you stand up
  • Diabetic ketoacidosis (increased levels of ketones in your blood or urine). Symptoms can include:
    • excessive thirst
    • urinating more often than normal
    • nausea
    • vomiting
    • stomach pain
    • tiredness
    • weakness
    • shortness of breath
    • breath that smells fruity
    • confusion
  • Kidney damage. Symptoms can include:
    • urinating less often than normal
    • swelling in your legs, ankles, or feet
    • confusion
    • fatigue
    • nausea
    • chest pain or pressure
    • irregular heartbeat
    • seizures
  • Hypoglycemia (low blood sugar). Symptoms can include:
    • drowsiness
    • headache
    • confusion
    • weakness
    • hunger
    • irritability
    • sweating
    • feeling jittery
    • fast heartbeat
  • Fournier's gangrene (severe infection near the genitals). Symptoms can include:
    • pain, tenderness, swelling, or reddening in your genital or rectal area
    • fever
    • malaise (overall feeling of discomfort)
  • Severe allergic reaction. Symptoms can include:
    • rash
    • itchy skin
    • flushing (warmth and redness in your skin)
    • swelling
    • trouble breathing
  • Bone fractures. Symptoms can include:
    • pain
    • swelling
    • tenderness
    • bruising
    • deformity
  • Increased cholesterol levels
  • Amputation of lower limbs

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 cause.

Allergic reaction

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

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Only a few patients in clinical studies reported severe allergic reactions while taking Invokana. Symptoms of a severe allergic reaction can include:

  • angioedema (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. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Amputation

Invokana has a boxed warning for the amputation of lower limbs. A boxed warning is the most serious warning the Food and Drug Administration (FDA) requires.

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

  • type 2 diabetes and heart disease, or
  • type 2 diabetes and were at risk for heart disease

Up to 3.5 percent 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.

Before you start taking Invokana, talk with your doctor about the possible risks. 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.

Fournier's gangrene

Fournier's gangrene is a rare infection of the area between your genitals and rectum.

People in clinical trials of Invokana didn't get Fournier's gangrene. But after the FDA approved the drug, some people reported getting Fournier's gangrene while taking Invokana or other drugs in the same class. More serious cases of the condition have led to hospitalization, multiple surgeries, or 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.

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. Up to 11.6 percent of the women and 4.2 percent of the men in the clinical trials 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 occurs when the cells of your body don't get the glucose (sugar) they need for energy. Without this sugar, your body uses fat for energy. This can cause high levels of acidic chemicals called ketones in your blood.

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

Kidney damage

Taking Invokana can increase your risk for kidney damage. After the FDA approved the drug, 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 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.

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 percent 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.

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.

Pancreatitis (not a side effect)

Pancreatitis (inflamed 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 medication). Because of these similar results, it's not likely that Invokana caused the pancreatitis.

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. The FDA released a safety announcement for a different class of diabetes drug called dipeptidyl peptidase-4 (DPP-4) inhibitors. The announcement said that DPP-4 inhibitors may cause severe joint pain.

Invokana belongs to a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors.

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

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 mg (a yellow tablet) and 300 mg (a white tablet).

Dosage for type 2 diabetes

If you have type 2 diabetes, the recommended starting dose is 100 mg once a day. It's best to take your dose before breakfast.

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 type 2 diabetes. 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.

Examples of other drugs that may be used to treat type 2 diabetes include:

  • sodium-glucose co-transporter 2 (SGLT-2) inhibitors, such as:
    • empagliflozin (Jardiance)
    • dapagflozin (Farxiga)
    • ertugliflozin (Steglatro)
  • incretin mimetics/glucagon-like peptide-1 (GLP-1) receptor agonists, such as:
    • dulaglutide (Trulicity)
    • exenatide (Bydureon, Byetta)
    • liraglutide (Victoza)
    • lixisenatide (Adlyxin)
    • semaglutide (Ozempic)
    • albiglutide (Tanzeum)
    • metformin (Glucophage, Glumetza, Riomet)
  • dipeptidyl peptidase-4 (DPP-4) inhibitors, such as:
    • alogliptin (Nesina)
    • linagliptin (Tradjenta)
    • saxagliptin (Onglyza)
    • sitagliptin (Januvia)
  • thiazolidinediones, such as:
    • pioglitazone (Actos)
    • rosiglitazone (Avandia)
  • alpha-glucosidase inhibitors, such as:
    • acarbose (Precose)
    • miglitol (Glyset)
  • sulfonylureas, such as:
    • chlorpropamide
    • glimepiride (Amaryl)
    • glipizide (Glucotrol)
    • glyburide (Diabeta, Glynase PresTabs)

You may wonder how Invokana compares to other medications that are prescribed to treat 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 FDA-approved to:

  • improve blood sugar levels in adults with type 2 diabetes
  • reduce the risk of heart attack, stroke, and death in people with type 2 diabetes and heart disease

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).

  • Can occur with Invokana:
    • thirst
    • constipation
  • Can occur with Jardiance:
    • joint pain
  • Can occur with both Invokana and Jardiance:
    • urinary tract infections
    • urinating more often than normal
    • nausea
    • vaginal itching
    • yeast infections in men and women
    • higher cholesterol levels

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).

  • Can occur with Invokana:
    • amputation of a lower limb
    • bone fractures
  • Can occur with Jardiance:
    • few unique serious side effects
  • Can occur with both Invokana and Jardiance:
    • dehydration, which can cause low blood pressure
    • diabetic ketoacidosis (increased levels of ketones in the blood or urine)
    • kidney damage*
    • serious urinary tract infections
    • hypoglycemia (low blood sugar)
    • Fournier's gangrene
    • severe allergic reaction

* 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 treating type 2 diabetes.

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 FDA-approved to improve blood sugar levels in adults with type 2 diabetes. Invokana is also approved to reduce the risk of heart attack, stroke, and death in people with type 2 diabetes and heart disease.

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:
    • urinary tract infections
    • urinating more often than normal
    • nausea
    • constipation
    • vaginal itching
    • yeast infections in men and women
    • higher cholesterol levels

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).

  • Can occur with Invokana:
    • amputation of a lower limb
  • Can occur with Farxiga:
    • few unique serious side effects
  • Can occur with both Invokana and Farxiga:
    • bone fractures
    • dehydration, which can cause low blood pressure
    • diabetic ketoacidosis (increased levels of ketones in the blood or urine)
    • kidney damage*
    • serious urinary tract infections
    • hypoglycemia (low blood sugar)
    • Fournier's gangrene (severe infection near the genitals)
    • severe allergic reaction

* 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 Jardiance to be effective for treating type 2 diabetes.

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 for type 2 diabetes

Invokana is FDA-approved to improve blood sugar control in adults with type 2 diabetes. This is a condition in which glucose (sugar) builds up in your blood.

The hormone insulin normally moves sugar from your blood into your cells. But with type 2 diabetes, your body doesn't react to insulin properly. And over time, your body may stop making enough insulin.

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

Invokana is sometimes used off-label to treat type 1 diabetes. In one clinical study, people with type 1 diabetes took Invokana and insulin. For the people in the study, this treatment reduced:

  • their blood sugar level
  • their hemoglobin A1c (HbA1c) level
  • the total amount of insulin they had to take each day

Don't take Invokana for type 1 diabetes unless your doctor has prescribed it for you.

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:

  • hypoglycemia (low blood sugar)
  • diabetic ketoacidosis (increased levels of ketones in blood and urine)
  • pancreatitis (inflamed pancreas)

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 is a list of medications that can interact with Invokana. This list doesn't contain all 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.

Drugs that can increase the risk of hypoglycemia

Taking Invokana with certain medications can increase your risk for hypoglycemia (low blood sugar). 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:

  • other diabetes drugs, such as:
    • dulaglutide (Trulicity)
    • linagliptin (Tradjenta)
    • liraglutide (Victoza)
    • sitagliptin (Januvia)
    • glyburide (DiaBeta, Glynase, Micronase)
    • glimepiride (Amaryl)
    • glipizide (Glucotrol)
    • meal-time insulins (Humalog, Novolog)
    • metformin (Glucophage)
    • nateglinide (Starlix)
    • repaglinide (Prandin)
  • certain high blood pressure medications, such as:
    • benazepril (Lotensin)
    • candesartan (Atacand)
    • enalapril (Vasotec)
    • irbesartan (Avapro)
    • lisinopril (Zestril)
    • losartan (Cozaar)
    • olmesartan (Benicar)
    • valsartan (Diovan)
  • other medications that can lower blood sugar levels, such as:
    • disopyramide (Norpace)
    • certain cholesterol medications, such as fenofibrate (Tricor, Triglide) and gemfibrozil (Lopid)
    • certain antidepressants, such as fluoxetine (Prozac, Sarafem) and selegiline (Emsam, Zelapar)
    • octreotide (Sandostatin)
    • sulfamethoxazole-trimethoprim (Bactrim, Septra)

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). Also, your doctor may need to change your dosages.

Examples of these medications include:

  • albuterol (ProAir, Proventil, Ventolin)
  • certain antivirals, such as atazanavir (Reyataz) and lopinavir/ritonavir (Kaletra)
  • certain steroids, such as budesonide (Entocort EC, Pulmicort, Uceris), prednisone, and fluticasone (Flonase, Flovent)
  • certain diuretics, such as chlorothiazide (Diuril) and hydrochlorothiazide (Microzide)
  • certain antipsychotics, such as clozapine (Clozaril, Fazaclo) and olanzapine (Zyprexa)
  • certain hormones, such as danazol (Danazol), levothyroxine (Levoxyl, Synthroid), and somatropin (Genotropin)
  • glucagon (GlucaGen)
  • niacin (Niaspan, Slo-Niacin, others)
  • oral contraceptives (birth control pills)

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)

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). Examples of these include:

  • alpha-lipoic acid
  • bitter melon
  • chromium
  • gymnema
  • prickly pear cactus

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:

  • glimepiride (Amaryl)
  • glipizide (Glucotrol)
  • glyburide (DiaBeta, Glynase)
  • metformin (Glucophage, Glumetza, Riomet — see below)
  • pioglitazone (Actos)

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 helps improve blood sugar levels in adults with type 2 diabetes. This is a condition in which glucose (sugar) builds up in your blood. The hormone insulin normally moves sugar from your blood into your cells. But with type 2 diabetes, your body doesn't react to insulin properly. Over time, your body may stop making enough insulin.

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. Invokana helps sugar leave the body through your urine.

How long does it take to work?

Invokana starts to work right after you take it. But it's at its most effective about one to two 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 the fetus when the mother was given the drug. Because of these studies, Invokana shouldn't be used during the second and third trimesters of pregnancy.

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 breast milk. However, it's best to wait until after you've finished breastfeeding before you take Invokana. Results of animal studies showed a possible risk of kidney problems in the fetus when the mother was given the drug.

If you're planning to breastfeed, talk with your doctor. The two of 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.

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.

Why has the Food and Drug Administration (FDA) issued a warning on Invokana?

Data from clinical studies showed that taking Invokana may increase the risk of leg and foot amputations. As a result, the FDA issued a statement about this risk. In addition, they now require a boxed warning about amputations on the Invokana label. A boxed warning is the most serious warning the FDA requires.

How do I know if Invokana is working?

Check your blood sugar level regularly to make sure it's within the goals you and your doctor have set. The two of you can track your progress with these checks and with blood tests, including A1C tests. The results can show how Invokana and any other diabetes drugs you take are working.

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 percent 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.

Invokana has a boxed warning about amputation of a lower limb. A boxed warning is the most serious warning the Food and Drug Administration (FDA) requires.

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.

This drug comes with several warnings.

FDA warning: Risk of lower limb amputation

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Two studies found that taking Invokana increases the risk of amputation of a lower limb. 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 the possible risks. 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

If you're concerned about these side effects or have questions about Invokana, talk with your doctor.

Other warnings

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:

  • 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.
  • High cholesterol: Invokana may increase your cholesterol levels. If you already have high cholesterol, your doctor will likely monitor your levels closely while you take Invokana.

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), 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 to improve glycemic control in adults with type 2 diabetes mellitus. It's an adjunct to diet and exercise.

It's also approved to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease. These cardiovascular events include cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

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 one to two 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 percent.

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 the following patients:

  • those with a serious hypersensitivity reaction to Invokana
  • those with severe renal impairment (eGFR less than 30 mL/min/1.73 m2) or end-stage renal disease
  • those who are on dialysis

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.