From the Guidelines
Invokana (canagliflozin) is recommended as a first-line treatment for patients with type 2 diabetes and established cardiovascular disease or kidney problems, due to its proven benefits in reducing the risk of heart attack, stroke, and heart failure, as demonstrated in the CANVAS Program trial 1. The typical starting dose is 100 mg taken once daily before the first meal of the day, with a possible increase to 300 mg daily if needed and tolerated. Invokana works by preventing the kidneys from reabsorbing glucose, causing excess sugar to be eliminated through urine. Some key benefits of Invokana include:
- Reducing the risk of heart attack, stroke, and heart failure, particularly in patients with existing cardiovascular disease or kidney problems, as shown in the CANVAS Program trial 1
- Helping with modest weight loss and blood pressure reduction
- Reducing the risk of cardiovascular death, MI, or stroke, as demonstrated in the CREDENCE trial 1 Some potential side effects to consider:
- Genital yeast infections
- Urinary tract infections
- Increased urination
- Diabetic ketoacidosis
- Kidney problems
- Increased risk of lower limb amputations, although this risk was not significant in the CREDENCE trial 1 It is essential to maintain adequate hydration while taking this medication and to regularly monitor kidney function. According to the 2022 guideline, SGLT2 inhibitors like canagliflozin may be more useful for patients at high risk of CKD progression, and can be started with an eGFR >30 mL/min/1.73 m2 1.
From the FDA Drug Label
INVOKANA can cause serious side effects, including: Diabetic ketoacidosis (increased ketones in your blood or urine) in people with type 1 and other ketoacidosis. INVOKANA can cause ketoacidosis that can be life-threatening and may lead to death. Ketoacidosis is a serious condition which needs to be treated in a hospital. People with type 1 diabetes have a high risk of getting ketoacidosis. People with type 2 diabetes or pancreas problems also have an increased risk of getting ketoacidosis Ketoacidosis can also happen in people who: are sick, cannot eat or drink as usual, skip meals, are on a diet high in fat and low in carbohydrates (ketogenic diet), take less than the usual amount of insulin or miss insulin doses, drink too much alcohol, have a loss of too much fluid from the body (volume depletion), or who have surgery or a procedure that requires not having food for a long time (prolonged fasting). Ketoacidosis can happen even if your blood sugar is less than 250 mg/dL.
Invokana can cause serious side effects, including diabetic ketoacidosis, which can be life-threatening and may lead to death.
- Key points to consider:
- People with type 1 diabetes have a high risk of getting ketoacidosis.
- People with type 2 diabetes or pancreas problems also have an increased risk of getting ketoacidosis.
- Ketoacidosis can happen even if your blood sugar is less than 250 mg/dL.
- Patients should be advised to report immediately any signs or symptoms suggesting allergic reaction and to discontinue the drug until they have consulted prescribing physicians 2.
- The use of INVOKANA has not been studied in patients with severe hepatic impairment and is therefore not recommended 2.
From the Research
Invokana Overview
- Invokana, also known as canagliflozin, is a sodium-glucose co-transporter-2 (SGLT2) inhibitor used in the treatment of patients with type 2 diabetes mellitus 3, 4.
- It works by inhibiting the transporter protein SGLT2 in the kidneys, reducing renal glucose reabsorption, and increasing urinary glucose excretion, thereby reducing blood glucose levels 3, 4.
Efficacy and Safety
- Canagliflozin has been shown to improve glycaemic control when used as monotherapy or as add-on therapy to metformin and/or other antihyperglycaemic agents, including insulin, in patients with type 2 diabetes 3, 5, 6.
- It has also been associated with beneficial effects on body weight and blood pressure 3, 4, 6.
- The most frequently reported adverse events with canagliflozin are female genital mycotic infections, urinary tract infections, and increased urination 3, 4, 5, 6.
- Canagliflozin has a low risk of hypoglycaemia and is generally well tolerated in clinical trials 3, 4, 5, 6.
Clinical Trials
- Several randomized placebo- or active comparator-controlled trials have demonstrated the efficacy and safety of canagliflozin in patients with type 2 diabetes 3, 4, 5, 6.
- The CANVAS Program, an integrated analysis of two large CV outcomes studies, showed that canagliflozin had beneficial effects on cardiovascular risk reduction and possible renal benefits in patients with type 2 diabetes at high cardiovascular risk 4.
- A dose-ranging study found that canagliflozin added to metformin significantly improved glycemic control in type 2 diabetes and was associated with low incidence of hypoglycemia and significant weight loss 5.