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Fact Checked

Invokana Side Effects: What You Should Know

One of the most common diseases that affect Americans is diabetes. The number of people that are diagnosed with diabetes every year is on the rise. According to the National Diabetes Statistics Report published by the Centers for Disease Control and Prevention (CDC), about 10.5 percent of the country’s population has diabetes. Among these individuals, approximately 21.4 percent have undiagnosed diabetes. Diabetes is characterized by abnormally high blood sugar levels. In a healthy individual, normal fasting blood sugar is under 99 mg/dL, whereas in a diabetic patient, fasting diabetic blood sugar level is higher than 126 mg/dL. Accumulation of high blood sugar levels can be dangerous as it can cause blindness, nerve damage, kidney damage, and adverse cardiovascular events like a heart attack or stroke. Having diabetes that is not diagnosed is especially dangerous as it can greatly increase the risk of these health complications.

Diabetes has no cure, meaning that it must be managed life-long with a treatment regimen that includes a combination of exercise, diet changes and prescription diabetes medication. There are many prescription drugs that are used to treat both type 1 and type 2 diabetes. These medications treat the cause of the disease, which is a problem with the way the body makes insulin, the hormone that is responsible for moving sugar out of the bloodstream and into cells where it can be converted into energy. Type 2 diabetes is more prevalent than type 1, and it is caused by either insufficient or non-functional insulin production. Medications used in the treatment of both types of diabetes are different, as type 1 diabetes is an autoimmune disease in which the body cannot produce any insulin. 

What is Invokana Used For?

Invokana, also known as the drug canagliflozin, is one of the top prescription medications used in the treatment of type 2 diabetes. The medication is prescribed to lower blood sugar levels in type 2 diabetes. It is also used to reduce the risk of a cardiovascular event like heart attack or stroke, or death due to a cardiovascular event from occurring in patients with type 2 diabetes and a history of cardiovascular disease. Another indication of Invokana is to reduce the risk of end-stage renal kidney disease, decreasing kidney function, hospitalization caused by heart failure, and death due to a cardiovascular event in patients with type 2 diabetes and diabetic nephropathy in which a certain amount of protein in the urine is present. 

Invokana belongs to the SGL-2 inhibitor class of anti-diabetic drugs. These drugs work by preventing glucose from being absorbed back into the bloodstream by the kidneys through inhibition of transporters in the kidneys that normally do this. Instead, excess glucose is excreted through urine and blood glucose levels are lowered as a result of this. Invokana is prescribed more frequently than other SGL-2 inhibitors for the treatment of type 2 diabetes, and it was the first SGL-2 inhibitor to be adopted in the United States. Notably, an Invokana prescription is not used for the treatment of type 1 diabetes.

What to know when taking Invokana

Invokana should not be used by patients with the following conditions:

  • Chronic kidney disease 
  • Patients that are currently on dialysis
  • Patients with type 1 diabetes 
  • Pregnant women in their second or third trimester
  • Breastfeeding women
  • Individuals under the age of 18

Additionally, patients with the following conditions should discuss this with their doctor before taking Invokana.

  • Heart problems
  • Previous amputations or diabetic foot ulcer
  • Circulation or nerve problems in the legs or feet
  • Kidney disease
  • Liver disease
  • Bladder infections
  • Urination problems
  • Pancreatic disorder
  • Diabetic ketoacidosis
  • Low sodium diet

The usual dosage is started at one Invokana 100 mg tablet per day and the medication should be taken before the first meal of the day. Gradually, the dose may be increased depending on how your body responds to the Invokana tablet. The maximum dosage of Invokana that can be taken per day is 300 mg. 

Side effects of Invokana

Invokana is associated with certain side effects. If you experience any of these side effects when taking the medication, it is important to inform your doctor. Some of these side effects are common and will subside once your body adjusts to the medication. 

The most common side effects that may occur are:

  • Frequent urination
  • Lightheadedness
  • Genital infections

Possible serious side effects associated with Invokana include the following:

  • Urinary tract infections that leads to hospitalization. Symptoms include burning while urinating, urgent need to urinate, pain in the lower part of the stomach, blood in urine, fever, back pain, nausea and vomiting. 
  • Low blood sugar (hypoglycemia)- This can occur if you take Invokana with other medications to treat diabetes that also lower your blood sugar level, such as insulin or drugs belonging to the sulfonylurea class. Symptoms include headache, drowsiness, feeling dizzy, confusion, hunger, fast heartbeat, sweating and shaking. Hypoglycemia can be a dangerous condition, so get emergency help if you experience these symptoms while taking Invokana. 
  • Broken bones or fractures- Invokana can increase your risk of getting a bone fracture, so it is important to talk to your doctor about ways to reduce this risk while taking the medication. 
  • Necrotizing fasciitis- this is a rare, but serious, bacterial infection that affects the skin around the anus and the genitals. Seek emergency medical help immediately if you experience pain, tenderness, or redness in those areas along with a fever or feeling weak. 

The following conditions are the most serious side effects of taking Invokana. Inform your doctor immediately if you develop symptoms of any of these conditions. 

  • Amputations- Invokana is associated with an increased risk of possible lower limb amputations. These usually involve the lower part of foot or the toe, but some patients have had amputations below and above the knee, and in either leg. You may be at increased risk for amputations when taking Invokana if you have a history of heart disease, blocked blood vessels in the leg, nerve damage in the leg, or have diabetic foot ulcers or sores. Be sure to discuss with your doctor urgently if you develop symptoms of pain, tenderness, sores, ulcers or infections in your foot. 
  • Dehydration. You may be at increased risk for dehydration when taking Invokana if you are on a low sodium diet, take medication to lower blood pressure such as diuretics, or if you are above the age of 65. Symptoms of dehydration are dizziness, lightheadedness, and feeling weak or faint when standing up especially from a lying down position. Your doctor can advise on how much fluid to drink and other factors that may help reduce the risk of dehydration from occurring. 
  • Ketoacidosis. This can occur in patients who take the drug with either type 1 or type 2 diabetes. Diabetic ketoacidosis is extremely dangerous and can lead to death if not promptly treated. Symptoms include nausea, vomiting, pain in the stomach area, tiredness, or trouble breathing.
  • Yeast infections in the vagina or penis- Symptoms of a vaginal yeast infection include vaginal odor, white or yellow discharge, and vaginal itching. A penile yeast infection may cause a rash, redness, itching or swelling of the penis, foul-smelling discharge and pain in the skin of the penis. 
  • Allergic Reaction- It is possible to experience an allergic reaction to Invokana if you are taking it for the first time. Symptoms of an allergy include rash, hives on the skin, swelling of the face, lips, mouth, tongue and throat, and difficulty breathing or swallowing. Seek emergency medical help if these symptoms occur. 

A summary of the more common side effects include:

  • Bladder pain
  • Bloody or cloudy urine
  • Decreased frequency or amount of urine
  • Difficult, burning, or painful urination
  • Smelly discharge from the penis
  • Frequent urination
  • Increased thirst
  • Vaginal itching or itching outside of the genitals
  • Loss of appetite
  • Lower back or side pain
  • Nausea
  • Pain during sexual intercourse
  • Pain in the skin around the penis
  • Redness, itching, or swelling of the penis
  • Swelling of the face, fingers, or lower legs
  • Troubled breathing
  • Unusual tiredness or weakness
  • Vaginal discharge without odor or with mild odor
  • Vomiting
  • Weight gain

Other, less common side effects that have been reported are: 

  • Anxiety
  • Blurry vision
  • Chills
  • Cold sweats
  • Confusion
  • Cool, pale skin
  • Depression
  • Dry mouth
  • Fast or irregular heartbeat
  • Feeling dizzy
  • Headache
  • Hives or welts, itching skin, rash
  • Increased hunger
  • Hive-like swellings on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • Nightmares
  • Redness of skin
  • Seizures
  • Shakiness
  • Slurred speech
  • Unusual tiredness or weakness

This not a complete list of side effects that may occur when taking Invokana. Additional side effects that are rare or less common are also possible and more information can be found here.  

Drug interactions 

Taking other drugs may affect the way Invokana works. Inform your doctor of any medications that you are taking to prevent an adverse drug reaction from occurring and to ensure that your Invokana prescription will work as it is indicated. The following medications may interfere with Invokana:

  • Insulin and other diabetes medications
  • Diuretics or ‘water pills’ that lower blood pressure
  • Digoxin, digitalis
  • Rifampin
  • Ritonavir
  • Seizure medications like phenobarbital and phenytoin

How to buy Invokana 

You can purchase Invokana from any major pharmacy or drugstore. Invokana is one of the more expensive diabetes medications and not all health insurance plans cover it. You can discover new ways to save on Invokana through a prescription drug discount card, like the one available from USA Rx to help you purchase the drug. While taking the drug, be sure to discuss any side effects and new symptoms with your doctor. Being aware of what side effects to expect can help you take the medication safely and in a way that will allow you to benefit the most.  

References:

1. https://www.invokana.com

2. https://www.drugs.com/sfx/invokana-side-effects.html

Published September 25th, 2020 by Chris Riley
Fact Checked by Chris Riley

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