No, a patient should not take both Invokana and Jardiance simultaneously for diabetes.
Both Invokana (canagliflozin) and Jardiance (empagliflozin) are SGLT2 inhibitors from the same drug class with identical mechanisms of action, making their concurrent use redundant and potentially harmful without providing additional benefit. 1
Why Combining Two SGLT2 Inhibitors Is Not Recommended
Same Mechanism, No Added Benefit
- Both medications work by blocking sodium-glucose cotransporter-2 in the kidneys to promote urinary glucose excretion 1
- Using two SGLT2 inhibitors together does not enhance glycemic control beyond what a single agent provides 1
- Current diabetes management guidelines recommend using only one SGLT2 inhibitor at a time 1, 2
Amplified Safety Risks
The combination would compound class-specific adverse effects without therapeutic advantage:
- Diabetic ketoacidosis risk: Both drugs carry warnings for this potentially life-threatening complication, and dual therapy would increase this risk 3, 4
- Volume depletion and hypotension: Both cause intravascular volume contraction through increased urination; combining them intensifies dehydration risk, particularly in elderly patients or those on diuretics 3
- Genital mycotic infections: Both increase infection risk (approximately 6% vs 1% with placebo); dual therapy would further elevate this risk 2, 3
- Acute kidney injury: Both can cause transient changes in kidney function; concurrent use may worsen renal outcomes 3
Specific Concerns with Canagliflozin
- Canagliflozin (Invokana) carries an FDA Black Box Warning for increased lower-limb amputation risk, particularly affecting toes and midfoot 5, 4
- Canagliflozin is also associated with increased bone fracture risk 5, 4
- These risks would not be mitigated by adding empagliflozin 4
The Correct Approach: Choose One SGLT2 Inhibitor
Select a single SGLT2 inhibitor based on patient-specific factors:
- For cardiovascular disease: Both empagliflozin and canagliflozin have proven cardiovascular benefits 1, 6
- For chronic kidney disease: Canagliflozin, dapagliflozin, and empagliflozin all demonstrate kidney protection; initiate at eGFR ≥20 mL/min/1.73 m² 2
- For heart failure: Empagliflozin and dapagliflozin have the strongest evidence for heart failure with reduced ejection fraction 6
- Avoid canagliflozin in patients with peripheral vascular disease, prior amputation, neuropathy, or osteoporosis risk 5, 7
If Additional Glucose Lowering Is Needed
Rather than combining two SGLT2 inhibitors, guidelines support adding a different drug class:
- GLP-1 receptor agonist: The combination of an SGLT2 inhibitor with a GLP-1 receptor agonist is explicitly supported by guidelines and demonstrates additive benefits for blood pressure and weight reduction 7
- Metformin: Remains first-line therapy and can be safely combined with SGLT2 inhibitors 1, 2
- Insulin or other agents: Dose adjustments may be needed to prevent hypoglycemia 7
Critical Monitoring If Patient Is Currently on Both
If a patient is inadvertently taking both medications, immediate action is required:
- Discontinue one SGLT2 inhibitor immediately 1
- Monitor for signs of ketoacidosis (nausea, vomiting, abdominal pain, shortness of breath) even with normal blood glucose 3
- Assess volume status and kidney function 3
- Check for genital or urinary tract infections 3
- Adjust doses of other diabetes medications to prevent hypoglycemia 7