Brand Name: Invokana
Generic Name: canagliflozin

Drug Class: Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitor
Similar Drugs: Farxiga (dapagliflozin), Jardiance (empagliflozin)
Manufacturer: Janssen
Approval Date: March 29, 2013

What is Invokana and how does it work?                                                      

Invokana is a medication that decreases blood glucose (sugar) in people with diabetes by blocking the kidney from reabsorbing glucose and removing excess glucose through the urine. It does this by blocking the sodium-glucose co-transporter-2 (SGLT2) which is a protein in the kidney that is responsible for reabsorbing glucose back into the body. Lowering high blood glucose can help prevent nerve problems, blindness, and kidney damage in people with diabetes. Proper control of blood glucose can also decrease the risk of getting a heart attack or stroke.

What does Invokana treat?

Invokana is a prescription medicine used along with diet and exercise to lower blood sugar in adults with Type-2 diabetes. It is not for people with Type-1 diabetes and diabetic ketoacidosis. It should not be used in patients with renal disease or who are on dialysis.  

How effective is Invokana?

Invokana’s efficacy is dependent on the filtration capacity of kidneys also known as glomerular filtration rate (GFR).

Invokana 100 and 300 mg once daily were evaluated as monotherapy and as add-on to other anti-diabetic agents. Both doses provided better reductions in HbA1C from baseline relative to placebo when used as a monotherapy and as an add-on therapy to metformin, sulfonylureas, metformin plus a sulfonylurea, metformin plus pioglitazone, and insulin.  

A 52-week, double-blind study enrolled 1,450 patients with type 2 diabetes who were inadequately controlled on metformin monotherapy. They received Invokana 100 mg or 300 mg, or glimepiride as an add-on therapy to metformin. The reductions in HBA1C were 0.82% for Invokana 100 mg, 0.93% for Invokana 300 mg, and 0.81% for glimepiride. Invokana 300 mg provided greater reduction from baseline in HbA1C compared to glimepiride, and the relative treatment difference was -0.12%. Also treatment with Invokana 100 mg and 300 mg daily showed more weight reduction as compared to glimepiride.

Weight loss for the various treatment groups were 4.2% for Invokana 100 mg, 4.7% for Invokana 300 mg, and 1% weight gain in the glimepiride group. The baseline average weight was 86.8 kg in the Invokana 100 mg group, and  86.6 kg in the Invokana 300 mg and glimepiride group.  

Invokana was compared to sitagliptin, both as an add-on combination therapy with metformin and sulfonylurea in 52-week, double-blind, active-controlled study which enrolled 755 patients with type 2 diabetes inadequately controlled on metformin and sulfonylurea. The subjects received Invokana 300 mg or sitagliptin 100 mg in combination with metformin and sulfonylurea. The change in HBA1C was 1.03% in Invokana 300 mg group compared to 0.66% in the sitagliptin group. Average weight loss was 2.5% in the Invokana group and 0.3% weight gain occurred in the sitagliptin group. 

Interesting Facts about Invokana

• Invokana is the first diabetes treatment approved in a new class of drugs known as sodium-glucose co-transporter 2 (SGLT2)inhibitors.
• Invokana is associated with weight loss and reductions in blood pressure.
• Invokana is not as effective in people with poor kidney function. 

What are side effects of Invokana?

Common side effects of Invokana are yeast infections, urinary tract infections, and increased urination. Serious side effects of Invokana include kidney problems, hyperkalemia (high levels of potassium in blood), and hypotension (low blood pressure). Invokana increases the risk of hypoglycemia (low blood sugar) when combined with other diabetes drugs that cause low blood glucose. 

What is the dosing of Invokana?

Invokana is available in 100 mg and 300 mg tablets. The starting dose of Invokana is 100 mg once daily taken before the first meal of the day. The dosage can be increased to 300 mg once daily if GFR is 60 mL/min/1.73 m2 or greater and blood glucose control is not adequate.

No dose adjustment is needed in patients with mild renal impairment (GFR of 60 mL/min/1.73 m2 or greater). The dose of Invokana is limited to 100 mg once daily in patients with moderate renal impairment with GFR of 45 to 60 mL/min/1.73 m2. Invokana should not be initiated in patients with a GFR less than 45 mL/min/1.73 m2. Assessment of renal function is recommended before starting treatment and during Invokana therapy. 

What are Invokana Drug Interactions

UGT Enzyme Inducers 

UDP glucuronosyl transferases (UGT) are enzymes that convert chemicals in the body to other types of chemicals that are more soluble in water and easier to remove from the body.  Combining Invokana with drugs that increase the action of UGT enzymes (for example, rifampin, phenytoin, phenobarbital, ritonavir) increases removal of Invokana from the body and may reduce efficacy of Invokana. The dose of Invokana may beed to be increased if combined with drugs that increase its removal from the body.

Digoxin

Invokana may increase blood levels of digoxin.  

What is the cost of Invokana?

Wholesale price of Invokana is $8.77 per tablet, or $263.10 for a one-month supply. Retail pharmacy prices are about $349 to $405. 

How to obtain prescription assistance for Invokana?

For obtaining prescription assistance and Invokana Savings Card adn Coupon visit Invokana Care Path.

Also Read

Farxiga (dapagliflozin) Price, Side Effects, Dosing, Weight Loss

Metformin HCL (Glucophage) for Diabetes: Side Effects, Dosage, Mechanism of Action

Invokana and Farxiga for Weight Loss Management

New Standards for Diabetes Medical Care 

New Drugs for Diabetes Treatment

References

Invokana FDA Prescribing Information (PI) and Drug Guide