Invokana (Canagliflozin)

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What Is Invokana?

Invokana is an oral SGLT-2 (sodium-glucose co-transporter-2) inhibitor containing canagliflozin (100 mg or 300 mg), manufactured by Janssen / Johnson & Johnson. Available in packs of 30, 60, 90 or 180 tablets. It is approved for:

• Type 2 diabetes — for glycaemic control, usually as add-on to metformin or as second line
• Heart failure — in both reduced (HFrEF) and preserved (HFpEF) ejection fraction, regardless of diabetes
• Chronic kidney disease — to slow progression, with or without diabetes

canagliflozin was first approved 2013 (originator brand: Invokana, Janssen / Johnson & Johnson). It is one of the most clinically important classes of antidiabetic in the last decade, because the same drug treats three of the most common long-term complications of diabetes simultaneously.

How Does Invokana Work?

Healthy kidneys filter 180 g of glucose per day through the glomeruli and reabsorb almost all of it back into the bloodstream via the SGLT-2 transporter in the proximal tubule. In diabetes, this reabsorption is actually up-regulated — the body holds on to more glucose precisely when it should be letting some go.

canagliflozin selectively blocks SGLT-2, causing 70–90 g of glucose per day to be excreted in urine. This:

• Lowers blood glucose by about 30–50 mg/dL — independent of insulin
• Reduces weight by 2–3 kg — urinary glucose loss equals ~280–320 kcal/day
• Reduces systolic blood pressure by 3–5 mmHg — partly osmotic diuresis, partly other pathways
• Reduces intraglomerular pressure — slowing CKD progression
• Improves cardiac energy metabolism — contributing to heart-failure benefits

Cardiovascular, Heart Failure, and Kidney Benefits

canagliflozin has an unusually strong outcome-trial dataset:

• CANVAS Program (2017) — reduced 3-point MACE in patients with type 2 diabetes and high cardiovascular risk.
• Reduced heart-failure hospitalisation in CANVAS and CREDENCE.
• CREDENCE (2019) — 30% reduction in a composite of end-stage kidney disease, doubling of creatinine, or renal/CV death. Stopped early for efficacy. Landmark trial for SGLT-2 in diabetic CKD.

These trials changed practice: SGLT-2 inhibitors are now recommended for any patient with type 2 diabetes who has established cardiovascular disease, heart failure, or CKD — regardless of HbA1c.

Dosage and Administration

Standard dose: 100 mg once daily before the first meal of the day. Titrate to 300 mg/day if glucose control is not adequate and eGFR is > 60. For CKD/CV indications: 100 mg/day.

• Once-daily dosing; timing can be fixed to a routine.
• No need to take with food (unless noted for canagliflozin).
• Miss a dose — take it if remembered within 12 hours; otherwise skip.
• Invokana/canagliflozin: initiation down to eGFR 30 mL/min/1.73 m²; continue until dialysis. Limit dose to 100 mg/day if eGFR < 60.
• Do not initiate during acute illness with dehydration (risk of AKI and euglycaemic DKA).
• Sick-day rules: pause the SGLT-2 inhibitor during any acute illness with vomiting, diarrhoea, or reduced oral intake. Restart when eating normally.

Efecte Secundare

Frecvente:

• Genital mycotic infections (thrush) — up to 10% of users, mostly women. Easily treated with antifungals.
• Urinary tract infections — modest excess; most are simple cystitis.
• Increased urination (polyuria), mild dehydration, dizziness on standing (postural hypotension) — especially in the first 2 weeks.
• Modest LDL-cholesterol rise (usually < 0.2 mmol/L).

Uncommon but important:

• Diabetic ketoacidosis (DKA) — rare (< 0.1% per year) but can occur at near-normal blood glucose (“euglycaemic DKA”). Risk factors: reduced carbohydrate intake, acute illness, surgery, insulin dose reduction. Symptoms: nausea, vomiting, abdominal pain, deep breathing. Stop the drug and seek urgent care.
• Volume depletion — higher risk in older adults, those on diuretics, or low baseline blood pressure.
• Acute kidney injury — usually pre-renal in setting of dehydration; reversible when drug is held.
• Fournier’s gangrene — extremely rare necrotising perineal infection; medical emergency.
• CANVAS showed a doubling of lower-limb amputation risk (mostly toe/forefoot). The signal was not replicated in CREDENCE or in later real-world data, and the FDA removed its boxed warning in 2020. Still, clinicians typically screen for peripheral artery disease and avoid canagliflozin in patients with prior amputation or foot ulcers.

Interacțiuni medicamentoase

• Diuretics (especially loop and thiazide) — additive volume loss; consider reducing diuretic dose when starting.
• Insulin and sulfonylureas — additive glucose-lowering; those doses may need reducing to avoid hypoglycaemia.
• Lithium — increased urinary loss can raise lithium levels.
• Rifampicin — reduces SGLT-2 inhibitor levels; a larger dose may be needed.
• Antihipertensive — additive BP-lowering; monitor for dizziness.

Who Should Not Take Invokana?

• Type 1 diabetes mellitus (unless off-label and specialist-supervised)
• Diabetic ketoacidosis — current or recent history
• Severe renal impairment below the initiation cutoff
• End-stage renal disease on dialysis (stop once on dialysis for empagliflozin; dapagliflozin may be continued per some protocols)
• Severe volume depletion or hypotension
• Pregnancy and breastfeeding — limited data; avoid
• Known hypersensitivity to SGLT-2 inhibitors
• Canagliflozin: prior lower-limb amputation or active foot ulcer (relative)

Storage

Store Invokana below 30°C in a dry place, in the original blister. Keep out of reach of children.

Întrebări frecvente

Is Invokana the same as canagliflozin?

Yes — Invokana contains canagliflozin as the active ingredient. Bioequivalence is required by regulatory authorities, so clinical effect is the same at the same dose.

Is canagliflozin safe — what about the amputation risk?

The amputation signal came from the CANVAS program (absolute risk 6.3 vs 3.4 per 1000 patient-years). The signal was not seen in CREDENCE or in most real-world studies, and the FDA removed its boxed warning in 2020. Most clinicians now consider canagliflozin safe for patients without prior amputation, active foot ulcer, or severe peripheral artery disease. Foot checks and shoe hygiene are advised on any SGLT-2 inhibitor.

Will Invokana help me lose weight?

Yes, modestly — typically 2–3 kg loss over 6–12 months. The weight loss is because your kidneys excrete 70–90 g of glucose (~280–320 kcal) per day in urine. It is real but limited — do not expect the dramatic effects seen with GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro).

Will Invokana lower my blood pressure?

Yes — expect about 3–5 mmHg systolic fall systolic fall. If you are already on blood-pressure medicines and close to target, you may need a dose reduction when starting Invokana to avoid dizziness.

Can Invokana cause thrush or UTIs?

Yes — genital thrush is the most common side effect (up to 10% of users, mostly women). It is usually mild and easily treated with topical or oral antifungals. Urinary tract infections are modestly more common but usually simple. Good hygiene helps; most patients do not need to stop the drug.

Can I take Invokana if my kidneys are not great?

Yes — and in fact, SGLT-2 inhibitors protect the kidneys in CKD. Initiation cutoffs differ by molecule (check renal dosing section), but once started they are typically continued down to dialysis because the kidney-protective effect persists even when the glucose-lowering effect has faded.

What do I do on sick days or before surgery?

Hold Invokana during any acute illness with dehydration, vomiting, or reduced oral intake, and during major surgery or fasting. This reduces the risk of euglycaemic DKA and acute kidney injury. Restart once eating and drinking normally.

Where can I buy Invokana online?

You can order Invokana (100 mg or 300 mg) from MedsBase in packs of 30, 60, 90 or 180 tablets. We ship worldwide, with discreet packaging and genuine WHO-GMP certified manufacturer stock.

Related Diabetes Medications

• Jardiance — Empagliflozin 25 mg (Boehringer)
• Forxiga — Dapagliflozin 5/10 mg (AstraZeneca)
• Invokana — Canagliflozin 100 mg (Janssen)
• Glyxambi — Empagliflozin + Linagliptin combo
• Januvia — Sitagliptin (DPP-4 alternative)
• Glycomet SR — Metformin sustained-release
• Browse all Diabetes Medications

Alternative conexe

Alte produse din Afecțiuni cronice pe care clienții le vizualizează de asemenea:

• Simlo 5
• Anacin
• Sertagress
• Cosart
• Tenvir AF

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