Key Points

• Your blood glucose (sugar) levels should start to decline within the first week after you start taking Invokana (generic name: canagliflozin). However, your results may be different from other patients, so check with your doctor if you have a concern about your blood sugar levels.
• Invokana is a long-term medication used in addition to diet and exercise to control blood glucose (sugar) in adults with type 2 diabetes. It is usually given either as a 100 mg or 300 mg oral tablet taken once daily before the first meal of the day. It is often used in combination with other glucose-lowering drugs, such as metformin.
• Invokana works by blocking the reabsorption of glucose by the kidney and increasing glucose excretion through the urine, which then lowers your blood glucose levels.

In studies performed by the manufacturer, plasma glucose (blood sugar) started to decline after the first dose of Invokana. The decline in blood sugar is “dose-dependent”, meaning a greater drop in your blood sugar levels will occur with higher doses. In patients with type 2 diabetes given 100 to 300 mg once daily doses over a 16-day dosing period, increases in urinary glucose excretion were seen.

“Steady-state” was reached after 4 to 5 days of once-daily dosing with Invokana 100 mg to 300 mg. Steady state is the time during which the concentration of the drug in the body stays consistent. In other words, steady state is when the rate of the drug going into your body is equal to the rate of drug elimination.

Although steady state levels are reached in 4 to 5 days, clinical effectiveness with Invokana will vary from person to person and may take longer due to your unique factors such as age, weight, amount of body fluid, additional medications you take, kidney or liver function, or your other medical conditions. Your doctor knows your medical condition the best and can give you specific information on your overall response to Invokana.

What did the FDA approve Invokana for?

Invokana is classified as an SGLT-2 (sodium-glucose co-transporter-2) inhibitor. It blocks proteins in the kidney that reabsorb sugar (glucose) back into the bloodstream which results in more glucose being excreted in the urine. This helps to lower blood sugar and improve A1C.

• Invokana, from Janssen, was first cleared by the FDA in March 2013 as an oral medication to help control blood sugar (glucose) in adults with type 2 diabetes. It is used in addition to an appropriate diet and exercise regimen. Its safety and effectiveness were evaluated in nine clinical trials with over 10,000 patients with type 2 diabetes.
• Invokana is also approved to lower your risk of heart attack, stroke, or death if you have type 2 diabetes and known heart or blood vessel disease.
• If you have diabetic kidney disease (nephropathy) with a certain amount of protein in your urine, Invokana can also reduce the risk of end-stage kidney disease, heart-related death, and hospitalization for heart failure.

Invokana may be added to other therapies, such as metformin, in patients with type 2 diabetes who are not achieving their goal A1C of <7.

Other FDA-approved medications in the SGLT-2 inhibitor class include empagliflozin (Jardiance), dapagliflozin (Farxiga), and ertugliflozin (Steglatro). These medicines come as single agents and can also be combined with metformin.

Length of clinical studies

Type 2 diabetes is long-term (chronic) disease. The full beneficial effects of Invokana on your heart and kidney require you to take your medication on a long-term basis. Your doctor may combine Invokana with other diabetes medication to further reduce your blood sugar levels or for added heart or kidney benefits.

In longer-term studies conducted by the manufacturer over 26 weeks, both the 100 mg and 300 mg once daily dose of Invokana (when used alone) resulted in significant reductions of blood glucose (A1C) to less than 7% when compared to an inactive placebo. The percent of patients achieving A1C <7% was also significantly greater than placebo. Reductions in body weight and blood pressure were also observed. Similar results were seen when Invokana was studied in combination with metformin or with metformin + sitagliptin (Januvia).

Studies looking at cardiovascular outcomes (heart attack, stroke, or death) were even longer, conducted over a mean of 149 weeks (2.8 years).

Do not stop taking your medication or adjust any doses without speaking to your doctor first.

Can any drug interactions affect how well Invokana works?

Using Invokana with certain drugs that induce certain enzymes in your body (UGT enzymes) may lower the effectiveness of Invokana in treating your diabetes. Using Invokana with these drugs could cause your blood sugar levels to increase.

Your doctor may need to increase your dose of Invokana if you take certain medications, such as rifampin, phenytoin, phenobarbital, or ritonavir. Your dose changes may also depend upon your kidney function.

It is important to tell your doctor and pharmacist about all other medications you use, including over-the-counter drugs, vitamins, herbs and dietary supplements. Do not stop using any medication without first talking to your doctor.

You can review Invokana drug interactions here, and discuss them with your doctor and pharmacist.

Bottom Line

Invokana starts to work quickly and blood sugar levels should begin to decline in the first week or two after you start taking this medication. However, each patient's response is individual. If you have concerns about your blood sugar levels, contact your doctor right away.

Certain drug interactions can affect the amount of Invokana in your bloodstream, so it's important to tell your doctor and pharmacist about all the medicines you take, even if they are over-the-counter or herbal medications.

Type 2 diabetes is a chronic (long-term) condition that usually requires life-long medication. The positive effects on your heart and kidney occur over the longer term, as well, so it's important to continue your medication as prescribed by your doctor. Don't stop your medicines or adjust any doses without talking to you doctor first.

This is not all the information you need to know about Invokana for safe and effective use. Review the full product information here, and speak to your health care provider if you have questions or concerns.