Key Points

• Invokana (canagliflozin) is an oral prescription tablet used to help manage blood sugar (glucose) in adults with type 2 diabetes. It is used in addition to an appropriate diet and exercise regimen.
• It is also used 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 is in a class of drugs known as sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors). SGLT-2 inhibitors block kidney proteins that help to reabsorb glucose (sugar) back into your blood and increase glucose excretion through the urine.

Invokana is not used in patients with type 1 diabetes or diabetic ketoacidosis (increased ketones in blood or urine).

Invokana carries a boxed warning of a greater risk for lower limb amputations, which may involve the toe, foot and leg. In studies, some patients had multiple amputations, some involving both limbs. Your doctor will monitor you for infections of ulcers of the lower limbs, and may need to stop treatment.

You may be at a higher risk of lower limb amputation if you:

• have a history of amputation have heart disease or are at risk for heart disease
• have had blocked or narrowed blood vessels, usually in your leg
• have damage to the nerves (neuropathy) in your leg
• have a history of diabetic foot ulcers or sores.

Who should not use Invokana?

You should not used Invokana if:

• you are allergic to canagliflozin or any ingredient in Invokana
• have severe kidney (renal) problems and use Invokana to lower your blood sugar
• are on dialysis.

Your doctor will check your kidney function before you begin treatment with Invokana.

What is the mechanism of action for Invokana?

Invokana is classified as an SGLT-2 (sodium-glucose co-transporter-2) inhibitor. Sodium-glucose co-transporter-2 (SGLT-2) proteins are found in the kidneys and are responsible for reabsorbing glucose (sugar) back into the blood.

Invokana blocks the function of the SGLT-2 proteins which results in more glucose being excreted in the urine.

SGLT-2 inhibitors are effective at lowering hemoglobin A1C levels, improving weight loss and lowering blood pressure. They carry a low risk of hypoglycemia (low blood sugar levels) when used alone.

Other FDA-approved medications in the SGLT-2 inhibitor class include empagliflozin (Jardiance), dapagliflozin (Farxiga), and ertugliflozin (Steglatro). These medicines come as single-ingredient products or combined with other diabetes medications.

How does Invokana treat my type 2 diabetes?

Patients living with type 2 diabetes:

• may not be able to make enough insulin
• may not make insulin that works well
• may make too much glucose (blood sugar).

A build-up of blood sugar can lead to serious health concerns with your heart, kidney, nerves, blood vessels and eyes. An appropriate diet, exercise and use of prescription medications such as Invokana may help to lower your blood sugar and health risks from type 2 diabetes.

Invokana can help you reach your A1C goal. A1C is a simple blood test that shows the average amount of sugar (glucose) in your blood over the past 2 to 3 months, letting you know how well your blood sugar is being controlled over time.

If needed, Invokana can also be used with other medications such as metformin to help control your blood sugar.

• Medications that contain both drugs are known as Invokamet (canagliflozin and metformin) and Invokamet XR (an extended-release form).
• Metformin works by increasing the cells ability to use glucose (blood sugar).
• It improves how your insulin works and decreases liver glucose production and absorption.

Invokana is not approved as a weight loss treatment, but in some people with type 2 diabetes, Invokana can lead to a 2% to 3% weight reduction. Your specific results may vary depending upon your dose or if you take other diabetes medicines.

When is the best time to take Invokana?

Invokana is normally taken once a day before your first meal of the day.

Always take your medicine exactly how your doctor tells you to take it. Your doctor may need to change your dose or you may need to use Invokana with other medications.

When Invokana is used with other drugs that also lower blood sugar, such as insulin or sulfonylureas, a risk of low blood sugar (hypoglycemia) is possible. Know how to recognize the signs and symptoms of low blood sugar.

What should I do if I miss my dose of Invokana?

• If you miss a dose of Invokana, take it as soon as you remember.
• If it is almost time for your next dose, skip the dose you missed. Take your next regularly scheduled dose on time.
• Do not take two doses of Invokana at the same time.
• Talk to your doctor or pharmacist if you have questions about a missed dose.

Bottom Line

Invokana is used to help you manage your blood sugar if you have type 2 diabetes. It can also help to protect your kidneys and lower your risk for heart-related hospitalization or death.

In patients with type 2 diabetes, Invokana works by blocking certain proteins in the kidney that absorb sugar back into the blood. It increases the amount of sugar that is excreted in your urine.

Invokana can be added to other types of medicines for type 2 diabetes, including metformin, to help you to meet your goals. You and your doctor will determine your best treatment option based on your condition, medical history, side effects and cost.

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