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Fact Checked

What is Invokana Used For?

Diabetes, one of the most prevalent diseases in the world, is caused by high blood sugar. According to the World Health Organization, the number of people afflicted with diabetes has risen steeply over the past three decades with more than 422 million people now affected by the disease. In the United States, the number of people with diabetes or pre-diabetes, a condition that predisposes an individual to the development of diabetes is not insignificant either. About 34 million people suffer from diabetes, and an estimated 122 million people have pre-diabetes or diabetes, as per the Centers for Disease Control and Prevention (CDC). Normally, the body produces insulin to process blood sugar into cells where it is converted into energy. In diabetes, insulin is defective, causing the accumulation of high blood sugar levels. When insulin does not function properly to lower one’s blood sugar levels, it can lead to additional serious health complications. 

Type 1 diabetes is an autoimmune condition in which the body does not produce insulin at all. This condition is much less common than type 2 diabetes that accounts for more than 85 percent of all diabetes. In type 2 diabetes, the body does not produce enough insulin to lower blood sugar levels, or the insulin that is produced does not function in the right way. Both types of diabetes are life-long conditions that have to be managed with treatment in order to prevent other serious health risks from occurring. If left untreated, diabetes can lead to the following, often fatal conditions:

  • Heart attack
  • Stroke 
  • Diabetic neuropathy (nerve damage)
  • Diabetic retinopathy that can lead to blindness (damage to the retina)
  • Diabetic nephropathy (kidney damage) 

What is Invokana?

Diabetes medications have a large share in the pharmaceutical market since the disease has such a high burden. Artificial insulin is one of the major types of prescription medications used to treat diabetes, but it is not the only one. There are several other prescription medications that are used to treat diabetes that are effective in controlling blood sugar levels. One of these medications is called Invokana, or canagliflozin. Invokana is marketed by the company Janssen Pharmaceuticals, and it was FDA-approved for the treatment of type 2 diabetes in 2013. Invokana is the first diabetes medication of its type to be approved for use in the United States. Compared to other diabetes medications like the widely taken metformin, Invokana is a third-line medication for diabetes treatment. This medication is usually prescribed along with dietary changes and exercise for treatment in diabetic patients that have a history of either cardiovascular disease or diabetic nephropathy also present. 

What is Invokana used for? 

Invokana is mainly prescribed for the following indications: 

  • To lower blood sugar in individuals with type 2 diabetes, along with diet change and an exercise program 
  • To lower the risk of an adverse cardiovascular event such as heart attack, stroke, or death due to these causes from occurring in patients with type 2 diabetes and a history of cardiovascular disease
  • To reduce the risk of end-stage kidney disease (ESKD), worsening of kidney function, hospitalization due to heart failure and cardiovascular death in adult patients with type 2 diabetes and diabetic nephropathy (kidney damage due to diabetes) that is marked by a certain amount of protein in the urine.  

Importantly, an Invokana prescription is not used for the treatment of type 1 diabetes, as it can seriously increase the risk of a dangerous condition called diabetic ketoacidosis in which there are high levels of ketones in the blood or urine. People with severe kidney disease or patients that are on dialysis should not use Invokana either. 

Type 2 diabetes can increase the pressure on the part of the kidneys that is responsible for filtration, called the glomerulus. As this pressure increases over time, a condition named diabetic kidney disease can occur, and this condition affects about one in three people with type 2 diabetes. Progression of diabetic kidney disease can range from mild to kidney failure and the disease advances in five stages. The disease can progress very slowly without showing any symptoms for a long time, so regular blood tests can be helpful in monitoring whether you have this condition and if you are at risk of developing serious complications related to renal function. If blood tests indicate some level of diabetic kidney disease, it is essential to take medication that can help with treatment and slow the progression of the disease. In these cases, Invokana is prescribed for treatment, as the drug was proven to lower the risk of end-stage renal kidney disease and decrease damage to kidney function through clinical trials. 

How does Invokana work? 

Invokana belongs to the class of drugs named the sodium glucose co-transporter-2 (SGL-2) inhibitors. This class of drugs prevents the reabsorption of glucose into the bloodstream by the kidneys. SGL-2 inhibitors, like Invokana, are named after the special transporters on the renal tubules of the kidneys that they inhibit. Through preventing the action of these transporters, excess amounts of glucose in the blood that occur in diabetes are excreted through urine instead of re-circulating in the blood. This allows the patient’s blood glucose level to decrease, and in turn a lower blood sugar level can further decrease other risks like death due to a cardiovascular event or end-stage renal kidney disease. 

How to take Invokana 

Your doctor will give you personalized directions on how to take Invokana, but generally, the medication is taken once a day before the first meal. Typically, the initial dosage is one Invokana 100 mg tablet daily. The dosage may be increased gradually as your body adjusts to the medication. The eGFR rate is an indication of kidney function and is measured through blood tests. The dosage of Invokana that is prescribed will greatly depend on the eGFR rate. Usually, Invokana is not given to diabetic patients with an eGFR rate below 45 mL/min as it has not been found to be effective in this context. 

The recommended dosage of Invokana will also depend on other medications you take for diabetes, such as insulin analogs, as taking Invokana together with other medications that lower blood glucose can lead to hypoglycemia, or low blood sugar levels. For this reason, a double dose of Invokana should never be taken. If you forget to take your Invokana tablet, take it as soon as you remember, or if it is too close to the next dose, skip the missed tablet and take Invokana according to your regular schedule. Invokana can also lower blood pressure, so patients that take medication for hypertension, such as diuretics, should inform their doctor. 

The most common Invokana side effects include frequent urination, genital infections, lightheadedness and an unusually dry mouth. Dehydration can also occur when taking SGL-2 inhibitors. 

How much does Invokana cost?

Currently, there are no generic versions of Invokana available so the cost of the medication can be quite high. The exact price you pay will depend on the pharmacy that you purchase it from, but the average current list price of Invokana is between $550 to $650 for 30 tablets. Additionally, many health insurance plans no longer cover Invokana because in 2019, two of the largest Pharmacy Benefit Managers, Express Scripts and Caremark, removed Invokana, along with 90 prescription medications, from their list of covered drugs. Medicare is also not guaranteed to cover an Invokana prescription, as only 57% of current Medicare Part D and Medicare Advantage plans include Invokana in their coverage list. Therefore, co-pays for purchasing Invokana can range from single digits all the way up to the full cost of the drug.  

Taking medication for diabetes is not optional and can be the difference between life and death for diabetic patients. These medications also have to be taken life-long since diabetes is a chronic condition that has to be managed. Paying such a high price for essential medication can cause financial strain on patients who have to purchase the drug regularly. Fortunately, there are other ways to potentially save on the price of Invokana. 

Where to buy and save on Invokana 

Invokana can be purchased from any major pharmacy chain or drug store like CVS, Walgreens or Rite Aid. If the medication is not covered by your health insurance plan, or if you do not have prescription drug coverage, there are a few ways you can purchase Invokana at a reduced cost from these pharmacies.

  • Manufacturer of Invokana, Janssen Pharmaceuticals, offers a Janssen CarePath Savings program that can reduce the co-pay of Invokana to $0 for the first month of treatment and a savings of up to $200 per month for remaining refills up to a maximum of $3000. Eligibility must be verified every year.   
  • People without health insurance coverage or with a limited annual income may be able to receive their medication free of cost through the Johnson & Johnson Patient Assistance Foundation, of which Janssen Pharmaceuticals is a subsidiary component. Proof of household income is necessary to qualify for this program. 
  • A prescription drug discount card can enable savings without any eligibility requirements. The free discount card available from USA Rx can be applied at more than 90% of pharmacies across the country and can be used to purchase Invokana and any other FDA-approved prescription drugs. You can check the discounted price of Invokana here

You can try out any of these savings options to help you afford purchasing Invokana on a regular basis. 

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

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