Invokana belongs to a class of drugs called sodium-glucose co-transporter 2 inhibitors or SLGT-2. It works by helping the kidneys remove glucose from your bloodstream.

This medicine is used together with diet and exercise to help control blood sugar levels in adults who have non-insulin dependent diabetes. It is used to reduce the risk of cardiovascular diseases such as heart attack, stroke, or death in adults with non-insulin dependent diabetes and established cardiovascular disease.

Controlling the blood sugar of a diabetic individual will help prevent the common complications of the disease, which include kidney damage, nerve problems, roblems like blindness, sexual function problems, and loss of limbs. Invokana is used by people with non-insulin dependent diabetes and heart problems to lower their risk of death from stroke or heart attack, the need to be hospitalized for heart failure, or death from heart disease.

Side Effects

Your doctor prescribed Invokana because he or she has deemed that the benefit to you is greater than the risk of adverse effects. Not everyone who uses these meds will experience serious repercussions.

The more common adverse effects of Invokana are the following:

• More often than normal urination
• Urinary tract infection
• Constipation
• Thirstiness
• Nausea
• Yeast infections in men and women
• Vaginal itching

Most of the common side effects normally go away within a few days or a couple of weeks. If the common side effects like urinary tract infection won’t go away or there are other adverse effects, consult your doctor or your pharmacist. If you feel that you have a urinary tract infections or yeast infection, you should immediately call your doctor.

Serious side effects

Invokana does not commonly result in serious side effects, but they may occur. Call your doctor immediately if you have serious side effects. If you feel your symptoms are life-threatening, or if you feel you have a medical emergency, call emergency medical service right away.

Serious side effects and their symptoms include dehydration, which can result in low blood pressure.

The symptoms of low blood pressure include the following:

• Feeling faint
• Dizziness
• Lightheadedness
• Weakness, especially when standing up
• Diabetic ketoacidosis or increased levels of ketones in the blood or urine.

Symptoms of diabetic ketoacidosis include the following:

• More often than normal urination
• Excessive thirst
• Vomiting
• Nausea
• Stomach pain
• Weakness
• Tiredness
• Shortness of breath
• Confusion
• Breath that smells fruity
• Kidney damage.

Symptoms of kidney damage include the following:

• Less than normal urination
• Confusion
• Swelling in the legs, ankles, or feet
• Nausea
• Fatigue
• Irregular heartbeat
• Chest pain or pressure
• Seizures
• Hypoglycemia or low blood glucose.

Symptoms of hypoglycemia include:

• Confusion
• Drowsiness
• Headache
• Hunger
• Weakness
• Sweating
• Irritability
• Fast heartbeat
• Feeling jittery
• Fournier’s gangrene or severe infection near the penis.

Symptoms of Fournier’s gangrene include the following:

• Fever
• Pain, swelling, reddening, or tenderness in your rectal or penis area
• An overall feeling of discomfort
• Severe allergic reaction.

Symptoms of a severe allergic reaction include the following:

• Itchy skin
• Rash
• Swelling
• Flushing
• Trouble breathing
• Bone fractures.

Symptoms of bone fractures include the following:

• Pain
• Tenderness
• Swelling
• Deformity
• Bruising
• Increased cholesterol levels
• Amputation of lower limbs

Details of side effects

You do not know the frequency of the occurrence of certain side effects. The following are details on certain side effects that Invokana may cause.

Allergic reaction

Some people may have an allergic reaction after taking this medication. In clinical studies, about 4.2 percent of people who took the drug Invokana have reported getting mild allergic reactions. Symptoms of a mild allergic reaction include the following:

• Itchiness
• Skin rash
• Flushing

A more severe allergic reaction, while rare, is possible. In clinical studies, only a few patients reported having severe allergic reactions while using Invokana. Symptoms of a severe allergic reaction may include:

• Trouble breathing
• Swelling of the tongue, mouth, or throat
• Angioedema or swelling under the skin, usually in the eyelids, hands, lips, or feet.

If you experience a severe allergic reaction while taking Invokana, make sure to call your physician right away. If you feel your symptoms are life-threatening, or if you feel you are having a medical emergency, call emergency medical service immediately.

Amputation

Invokana carries a boxed warning for the amputation of lower limbs. The boxed warning is the most serious warning issued by the Food and Drug Administration.

Studies have found an increased risk for lower limb amputation in people who have taken the drug Invokana and with the following conditions:

• non-insulin dependent diabetes and heart disease
• diabetics who are at risk for heart disease

Approximately 3.5 percent of those people who took these meds had an amputation. Invokana has double the risk of amputation compared to people who did not take the drug. The toe and the midfoot were the most common areas of amputation. Some individuals also reported having a leg amputation.

You must talk first to your doctor before you start taking Invokana. Your doctor will discuss with you the possible risks of taking these meds. Talking to your doctor becomes very important if you already had an amputation in the past or if you have nerve disorder, blood circulation problem, or diabetic foot ulcers.

Stop taking Invokana and call your physician immediately if you experience any of the following:

• Foot pain or tenderness
• Foot sores or ulcers
• Foot infection

Call emergency medical services immediately if you feel your symptoms are life-threatening or when you are having a medical emergency.

Fournier’s gangrene

This condition is an infection of the area between the rectum and your penis. It is a very rare infection.

People who participated in clinical trials of these meds did not get Fournier’s gangrene. After the FDA granted approval for Invokana and people started taking it, some individuals reported getting Fournier’s gangrene. The problem also occurred in people who have taken other drugs belonging to the same class as Invokana. There were reported cases of more serious infections that have led to hospitalization, multiple surgeries, or even death.

If you feel that you have Fournier’s gangrene, immediately call your physician. Your doctor may ask you to immediately stop taking the drug and recommend treatment for the infection.

Yeast infection

Taking Invokana may increase your risk for a yeast infection. Clinical trials have shown that both men and women who are taking Invokana have the same risk of yeast infection. About 11.6 percent of the women and 4.2 percent of the men who participated in the clinical trials experienced a yeast infection.

People who have had a yeast infection in the past and uncircumcised males are more likely to develop a yeast infection while taking Invokana. Frequent urinary tract infections also add to the problem.

If you developed a yeast infection while taking this medicine, talk to your doctor who can suggest ways of treating it.

Diabetic ketoacidosis

In very rare cases, some individuals who are taking Invokana may develop invokana side effects called diabetic ketoacidosis. The condition occurs when the body cells don’t get the glucose they need for energy. Without sugar, your body uses fat for energy, which can cause high levels of acidic chemicals called ketones in your blood.

In severe cases, diabetic ketoacidosis can lead to coma or death. If you believe you may have diabetic ketoacidosis, call your doctor immediately for medical advice diagnosis. If your symptoms are severe, call emergency medical services or proceed to the nearest emergency room for advice diagnosis or treatment for ketoacidosis .

Kidney damage

The use of Invokana may increase your risk of kidney damage. After the FDA approved the drug and people started taking it, some individuals reported poor kidneys functions. When these individuals stopped taking the drug, their kidneys began to work normally again. You must seek medical advice diagnosis or treatment if you encounter any pain, redness, or frequent urinary tract infection.

You are likely to have kidney problems if you have any of the following conditions:

• Dehydrated
• Kidney or heart problems
• Take other medications that affect your kidneys
• Older than age 65

Before your doctor prescribes Invokana, he will test how well your kidneys are working. He will not prescribe Invokana if you have kidney problems.

Your doctor will likely test how your kidneys are working during your treatment with this medicine. If your doctor detects any kidney problem, he may change your dose of the drug or stop your treatment with this drug.

Bone fractures

Some individuals who took Invokana while participating in the clinical study experienced bone fracture, although they were not usually severe.

Talk with your doctor before taking Invokana if you are at high risk for a fracture or you are concerned about breaking a bone. Your doctor can suggest ways of preventing this side effect

Falls

In different clinical trials, up to 2.1 percent of participants who took Invokana had a fall. The risk of falls was higher in the first few weeks of treatment.

Talk with your doctor if you have a fall while taking this medicine or if you are concerned about falling. He can suggest ways to help you prevent this side effect.

Indication and dosage

The dosage of Invokana that your doctor will prescribe depends on many factors, such as:

• Your age
• The type and severity of the condition being treated
• Other medical conditions you may have

Your doctor will usually start you on a low dosage. Then he will gradually adjust it over time to get to the right amount for you. Your doctor will finally prescribe the smallest dosage that will provide the desired effect.

You must take the dosage that your doctor prescribes for you. He will determine the best dosage that suits your needs.

Drug forms and strengths

Invokana is available as a tablet. It is available in two strengths: 100 mg, which is a yellow tablet, and 300 mg, which is a white tablet.

Dosage for non-insulin dependent diabetes

If you have non-insulin dependent diabetes, your recommended starting dose is 100 mg once daily. It is ideal to take your dose of this medication before breakfast.

Missed dose

If you miss a dose of this medication, take it right as soon as you remember. Skip the missed dose and take the next dose at the usual schedule if you remember missing a dose when it is almost time for the next one. Do not make up for a missed dose by taking two doses at a time. This will be dangerous and can cause serious side effects.

You can remember to take your daily dose of Invokana by using a reminder tool.

Be sure to take Invokana exactly as your doctor prescribed.

Drug Interaction

Drug interactions could change the way your medications work or it may increase the risk for serious side effects. Provide your doctor with a list of all medications you are currently taking for him to check if any of them could interact with Invokana when you start taking the medication. Do not start taking any new medication, stop taking or change the dosage of any of your medications with the approval of your doctor.

Beta-blocker medications such as propranolol, metoprolol, and glaucoma eye drops may prevent the pounding heartbeat that you would normally experience when you have hypoglycemia or low blood glucose These drugs do not affect other low glucose symptoms, such as hunger, dizziness, or sweating.

Many medications affect your glucose level, making it harder to control. Before you start, stop, or change any medication, discuss with your doctor about how they may affect your blood glucose. You should check your blood sugar regularly as instructed and share the results with your doctor. Immediately report to your doctor if you experience any symptoms of high or low blood sugar. Your doctor may have to adjust your diabetes medication, diet, or exercise program.

When you take Invokana, your urine will test positive for glucose. Inform your doctors and other health professionals that you are taking this medicine.

Warnings and Precautions

In very rare cases, Invokana may increase your risk of losing a lower limb. The risk may be greater in individuals who have a history of heart problems, nerve problems, peripheral vascular disease, foot ulcers, or previous loss of limbs. Immediately report to your doctor if you have any tenderness, pain, swelling, or sores on your legs and feet.

Before using this medication, inform your doctor if you are allergic to Invokana canagliflozin, or if you have other allergies. Invokana may contain some inactive ingredients that can trigger allergic reactions or other problems.

Before you start taking Invokana, share with your doctor your medical history, especially if you ever had any of the following: kidney disease, low blood pressure, heart failure, dehydration, alcohol abuse, mineral imbalances, history of yeast infections in the penis or vagina.

While taking Invokana, you may experience dizziness, blurred vision, or drowsiness due to extremely low or high glucose. Do not drive, operate machinery, or perform any activity requiring clear vision or alertness until you are sure that you can safely perform such activities.

Limit your consumption of alcohol while taking Invokana as it can increase the risk of you developing low blood glucose and a high ketone level.

Your glucose level will be difficult to control when your body is stressed due to a variety of reasons including fever, injury, infection, or surgery. The inability to eat well due to these conditions or any other illness may lead to high ketone levels while you are taking Invokana canagliflozin. You need to see your doctor as this may require a change in the treatment plan, medications, or ketone or blood sugar testing.

Before undergoing any surgical procedure, inform your healthcare professional about all the medications you are currently taking.

Older adult patients are more sensitive to the side effects of Invokana, especially fainting or dizziness, bone loss or dehydration.

Invokana should be used only when clearly needed during pregnancy. Discuss with your doctor the benefits and risks of taking Invokana during your pregnancy.

Diabetes may get worse during pregnancy. Plan with your doctor how to manage your blood glucoseduring pregnancy. Your doctor may change your diabetes treatment during your pregnancy.

It is not known if Invokana passes into breast milk. Consult first with your doctor before you start to breastfeed your baby.

Overdose and Contraindications

Call emergency medical services (911 in the US) if someone has overdosed and manifesting serious symptoms such as trouble breathing or passing. If you believe you have overdosed on Invokana but do not feel yet any serious symptoms, you may call your local poison center at 1-800-222-1222.

If you miss a dose of Invokana, take the missed dose right as soon as you remember. When you remember missing a dose and it is close to your next regular dose, skip the dose you have missed and just take your next dose at the regular schedule. Do not double your dose of Invokana to make up for a missed dose.

Contraindications

The following conditions are contraindicated with Invokana. Consult your doctor if you have any of the following:

• High cholesterol
• Low blood glucose
• Chronic heart failure
• High levels of blood potassium
• Peripheral vascular disease
• Pregnant and or planning to breastfeed
• Decreased calcification or density of bone
• Diabetic complications resulting in injury to some nerves in the body
• Diabetic foot infection
• History of diabetes-related lower-limb amputation
• A condition where deep tissues die in the area of the genitals to the anus
• Necrotizing fasciitis
• Chronic kidney disease stage 4
• Chronic kidney disease stage 5

Clinical Pharmacology

SGLT2 or sodium-glucose co-transporter 2, conveyed in the immediate renal tubules are responsible for most of the reabsorption of filtered blood glucose from the tubular lumen. Invokana or canagliflozin is an inhibitor of SGLT2. Through this action, Invokana reduces the reabsorption of filtered blood sugar and lowers the kidneys’ threshold for glucose, increasing urinary glucose secretion. It is usually given to patients with both types of diabetes.

Invokana as an SGLT2 inhibitor that is used together with exercise and diet to control blood glucose in adults with type 2 diabetes mellitus.

Medication Guide

Invokana comes as a tablet and you need a prescription for this. If you suspect you are pregnant, ask your healthcare provider or doctor for medical advice about side effects Take the meds by mouth one each day exactly as ordered by your doctor. Your doctor will tell you the dosage of Invokana to take and when to take it. He may change your dose if it is necessary. Invokana is best taken by patients before the first meal of the day. Yes, it should be taken without food.

Your doctor may prescribe Invokana along with other medications for diabetes as part of his medical advice diagnosis. There is a risk of low blood glucose when you take Invokana together with certain diabetes medicines.

You should stay on your prescribed diet and exercise while taking Invokana. Check your blood glucose as instructed by your doctor.

Your doctor may perform certain blood tests before starting you on Invokana dosing and during treatment as may be necessary. Your doctor may change the dose of Invokana based on the results of your blood tests.

Expect your doctor to regularly check your diabetes with regular blood tests, such as blood sugar levels and hemoglobin A1c.

When on this drug, patients are advised not to alter the Invokana dose or Invokana dosage assigned by the doctor. It is an FDA approved medicine, but can still have a wide range of effects on patients. It is always best to seek advice diagnosis or treatment for a physician for any adverse effects you may be experiencing.