Invokana (Canagliflozin) - Oral

What Is Invokana?

Invokana (canagliflozin) is a prescription oral medication used to help lower blood sugar in adults with type 2 diabetes.

It can also be used to reduce heart- or kidney-related risks if you have type 2 diabetes and established heart disease or diabetes-related kidney problems, respectively.

Invokana is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. It works by blocking the SGLT2. Cotransporters are proteins that allow different molecules to transport from one place to another in the body. SGLT2 is responsible for reabsorbing most of the blood sugar filtered by the kidney. This medication helps control your blood sugar by blocking the reabsorption of glucose (sugar) back to the body, leading to more blood sugar being excreted in the urine.

Invokana is available as a tablet to be taken by mouth.

Drug Facts

Generic Name: Canagliflozin

Brand Name: Invokana

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: SGLT-2 inhibitor (hypoglycemic agent) 

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Canagliflozin

Dosage Form(s): Tablet

What Is Invokana Used For?

The Food and Drug Administration (FDA) approved Invokana for use:

  • Along with a diet and exercise regimen to improve control of blood sugar in adults with type 2 diabetes.
  • To reduce the risk of heart attack, stroke, and other major cardiovascular events in those with type 2 diabetes and heart disease.
  • To lower the risk of end-stage kidney disease, kidney impairment, cardiovascular death, and hospitalization for heart failure in adults with diabetes-related kidney problems.

How to Take Invokana

You should always follow directions given to you by your prescribing healthcare provider on how to take Invokana. The usual dose of Invokana is one tablet daily before your first meal of the day.

This medication and other medications used to control blood sugar should be taken even if you are feeling well. Even if someone is feeling healthy, they may still have high blood sugar and be at risk for complications, such as chronic kidney disease or diabetic nerve pain.

Storage

Store Invokana in a cool, dry place. In general, medications should be kept away from areas where they may be exposed to hot temperatures, like above your stove, or in humid locations, like your bathroom. Also, keep your pills away from bright lights. These environments can impact how well the medication works. It is also important to ensure this medication is kept out of reach of children and pets to prevent accidental consumption.

Off-Label Uses

Although approved for use in managing type 2 diabetes, your healthcare provider may also prescribe Invokana off-label for other reasons. A healthcare provider may prescribe off-label treatments when the decision is supported by scientific evidence or expert clinical experience.

Invokana can be used off-label to manage heart failure in people with or without diabetes. It is also sometimes prescribed off-label for diabetic kidney disease.

How Long Does Invokana Take to Work?

Invokana is a relatively fast-acting drug that works in your body within one to two hours. The drug will reach its maximal effects in your body within four to five days, but the time it takes to see actual improvements in your blood sugar levels may vary from person to person.

What Are the Side Effects of Invokana?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

You may experience these most common side effects of Invokana:

Severe Side Effects

Call your healthcare provider 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:

  • Ketoacidosis (high levels of acids called ketones in the body): Symptoms can include confusion, fast breathing, fast heartbeat, intense stomach pain, or vomiting.
  • Hyperkalemia (high levels of potassium in the body): Symptoms of mood changes, muscle pain or weakness, a heartbeat that does not feel normal, or a fast heartbeat
  • Severe allergic reactions: Symptoms may include rash, tightness in the chest or throat, trouble breathing, or swelling of the mouth, face, lips, tongue, or throat.
  • Kidney problems: Symptoms can include difficulty passing urine, changes in how much urine is passed, or blood in the urine.

Long-Term Side Effects

Long-term use of this medication has increased the risk of bone fractures. Before starting this medication, you and your healthcare provider should discuss potential factors that contribute to fracture risk.

Report Side Effects

Invokana may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Invokana Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For type 2 diabetes and to lower risk of death in patients with type 2 diabetes and heart and blood vessel disease and end stage kidney disease:
      • Adults—At first, 100 milligrams (mg) once a day, taken before the first meal of the day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 300 mg once a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

In clinical trials, older people (aged 65 and above) had higher rates of hypovolemia (low fluid in the body) than younger adults, particularly with higher doses of Invokana. Close monitoring when starting or increasing the dose of this medication is required.

Invokana is not recommended for those with kidney problems, classified as an estimated glomerular filtration rate (eGFR) of 30 milliliters (mL)/minute or less. However, if you have been on it and tolerated it well, your healthcare provider may keep you on a low dose.

Your healthcare provider may not prescribe it if you are on dialysis as the medication cannot be eliminated or if you have severe liver problems. Invokana is not recommended in pregnant people or those who are breastfeeding.

Missed Dose

If you miss a dose of Invokana, take it as soon as you remember unless it is too close to the next scheduled dose. In that case, skip the missed dose and take your next one at its scheduled time. Do not take more than one dose at a time.

Missing one dose of this medication is not harmful, but it is important to take it daily to control your blood sugar.

Overdose: What Happens If I Take Too Much Invokana?

Taking too much Invokana would most likely cause hypoglycemia (low blood sugar) with symptoms such as:

  • Heart palpitations
  • Confusion
  • Shakiness and lightheadedness
  • Fainting

In the event of an overdose, you should immediately seek medical help and contact poison control for the latest recommendations.

What Happens If I Overdose on Invokana?

If you think you or someone else may have overdosed on Invokana, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Invokana, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine. Blood and urine tests may be needed to check for unwanted effects.

Using this medicine during the second and third part of your pregnancy can harm your unborn baby. If you think you have become pregnant while using this medicine, tell your doctor right away.

This medicine may increase your risk of having leg, toe, or midfoot amputation (leg removal surgery). Check with your doctor right away if you have pain, tenderness, sores or ulcers, or infections on your leg or foot.

Dizziness, lightheadedness, or fainting may occur with this medicine. This is more common if you have kidney disease, low blood pressure, or if you are taking a diuretic (water pill). Taking plenty of fluids each day may help. Drink plenty of water during exercise or in hot weather. Check with your doctor if you have severe nausea, vomiting, or diarrhea that does not stop. This may cause you to lose too much water.

Ketoacidosis (high ketones and acid in the blood) may occur while you are using this medicine. This can be life-threatening and requires immediate medical attention. Your doctor may give you insulin, fluid, and carbohydrate replacement to treat this condition. Tell your doctor right away if you have nausea, vomiting, trouble breathing, increased thirst or urination.

Check with your doctor right away if you have bloody urine, decrease in how much or how often you urinate, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

This medicine may cause vaginal yeast infections in women and yeast infections of the penis in men. This is more common in patients who have a history of genital yeast infections or in men who are not circumcised. Women may have a vaginal discharge, itching, or odor. Men may have redness, itching, swelling, or pain around the penis, or a discharge with a strong odor from the penis. Check with your doctor right away if you have any of these symptoms.

Serious allergic reactions may occur with this medicine. Check with your doctor right away if you have a skin rash, hives or welts, itching, redness of the skin, trouble breathing, or large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals.

This medicine may increase the risk of bone fractures. Ask your doctor about ways to keep your bones strong to help prevent fractures.

This medicine may cause hypoglycemia (low blood sugar). This is more common when this medicine is taken together with other diabetes medicines (eg, insulin, glipizide, or glyburide). Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly. Talk to your doctor about the best way to treat low blood sugar.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your diabetes medicine, overeat or do not follow your diet plan, have a fever or infection, or do not exercise as much as usual. Some symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed and dry skin, a fruit-like breath odor, increased frequency and amount of urination, ketones in the urine, loss of appetite, nausea or vomiting, rapid and deep breathing, tiredness, or unusual thirst. If symptoms of high blood sugar occur, check your blood sugar level and call your doctor for instructions.

This medicine may increase risk of having urinary tract infections, including pyelonephritis or urosepsis. Check with your doctor right away if you have bladder pain, bloody or cloudy urine, difficult, burning, or painful urination, or lower back or side pain.

This medicine may cause a rare but serious bacterial infection, called necrotizing fasciitis of the perineum or Fournier's gangrene, which can cause damage to the tissue under the skin in the area between and around the anus and genitals (perineum). Fournier's gangrene may lead to hospitalization, multiple surgeries, or death. Check with your doctor right away if you have fever, unusual tiredness or weakness, or pain, tenderness, redness, or swelling of the area between and around your anus and genitals.

This medicine may cause serious allergic reactions, including anaphylaxis or angioedema. These reactions can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, blistering, peeling, or loosening of the skin, fever or chills, trouble breathing or swallowing, or any swelling of your hands, face, mouth, or throat while you are using this medicine.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests (eg, urine glucose tests may not be accurate). Also, you may need to stop taking this medicine at least 3 days before you have surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Invokana?

Your healthcare provider may not prescribe Invokana if you have any of the following:

  • Type 1 diabetes
  • Diabetic ketoacidosis
  • History of serious allergic reactions to Invokana
  • Severe kidney problems, end-stage renal disease, or are on dialysis
  • Severe liver problems

What Other Medications Interact With Invokana?

In order to know what kinds of medications to avoid, it is important to understand how Invokana is breaking down in the body.

Once absorbed, Invokana is eliminated primarily by a class of proteins known as UDP-glucuronosyltransferase (UGT). Since Invokana is broken down by these proteins, drugs that increase the rate that these proteins work (known as inducers) can decrease Invokana's effect.

Examples of UGT inducers include:

Taking Invokana with digoxin, a medication typically used for heart failure can increase digoxin levels in the body. Your healthcare provider may need to monitor the effects of these drugs if you're taking them together.

What Medications Are Similar?

Other SGLT-2 inhibitors similar to Invokana include:

Several combination drugs pairing an SGLT-2 inhibitor with metformin are also available, including:

Some other commonly used medications for type 2 diabetes include:

This list is a list of drugs also prescribed for type 2 diabetes. It is NOT a list of drugs recommended to take with Invokana. In fact, you should not take these drugs together without your healthcare provider's approval. Discuss any questions or concerns with your pharmacist or a healthcare provider.

Frequently Asked Questions

  • What is Invokana used for?

    Invokana is a blood sugar lowering treatment option for adults with type 2 diabetes. It can also be used to reduce the risk of major cardiovascular events (e.g., heart attack or stroke) in adults with established type 2 diabetes and heart disease. Invokana is also indicated to reduce kidney complications in people with diabetes-related kidney problems. It is not used for type 1 diabetes.

  • How does Invokana work?

    Invokana is an SGLT-2 inhibitor, meaning it blocks SGLT-2 in the kidneys to prevent blood sugar from being reabsorbed in the body and increase glucose (sugar) excretion in the urine.

  • How expensive is Invokana? Is there a way I can get help paying for it?

    Invokana is a relatively expensive medication. A 30-day supply costs $600 on average without insurance. There is currently no generic equivalent medication on the market.

    While the medication may be expensive, there may be a savings program available from the manufacturer that could potentially lower the cost of your Invokana prescription.

How Can I Stay Healthy While Taking Invokana?

Taking Invokana as prescribed is key to controlling your blood sugar and staying healthy. Follow your healthcare provider's directions on how and when to take your medication. It is also important to check your blood sugar levels routinely to better manage your diabetes and reduce the risk of complications.

Along with taking this medication daily, it is recommended to follow a healthy diet and exercise plan. People with diabetes should understand how their eating habits affect blood sugar and incorporate sustainable, healthy goals into their diets. A registered dietitian nutritionist (RDN) can help you better understand how to adapt your eating plan to your condition. In addition, physical activity can also help lower blood sugar. Try incorporating an exercise that feels good to you. However, consult with your healthcare provider before starting a new exercise regimen.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

The author would like to recognize and thank Cody Ryan Thomas for contributing to this article.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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