Diabetes medications can be very helpful in helping patients reach their blood sugar goals.
Like any medical treatment, these medications come with potential risks and side effects.
If you’re taking Invokana or are thinking about starting it, it’s a good idea to be aware of the potential side effects you could experience.
In this article, we’ll review the common and rare side effects of Invokana, explain what Invokana is, how it works, and more.
About Invokana (Canagliflozin)
Invokana is the brand name for canagliflozin, a diabetes medication. It is in a class of drugs called SGLT2 inhibitors.
Invokana helps treat type 2 diabetes by increasing the amount of glucose removed from your body in your urine and reducing the amount of glucose reabsorbed in your kidneys.
This helps lower blood sugar levels without causing low blood sugar (hypoglycemia).
Invokana was first approved by the United States Food and Drug Administration (FDA) in 2013 to help lower blood sugar levels in adults with type 2 diabetes (along with diet and exercise).
Invokana also has FDA approvals to:
- Reduce the risk of major cardiovascular events (such as heart attack and stroke) in adults with type 2 diabetes who have known cardiovascular disease.
- Reduce the risk of end-stage kidney disease, worsening of kidney function, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic kidney disease (nephropathy) with a certain amount of protein in the urine.
The typical dosing of Invokana ranges from 100 milligrams-300 milligrams daily. The dosage will vary depending on your kidney function, blood sugar control, and other factors.
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What are the side effects of Invokana?
Invokana increases the amount of sugar in your urine. This means that if you have a urine test, it will likely be positive for glucose.
The presence of more sugar in your urine causes many of the most commonly reported adverse side effects of Invokana, such as:
- Female genital mycotic infections (yeast infections) – yeast feeds off the extra sugar to grow
- Urinary tract infections (bacteria also feed off the excess sugar)
- Increased urination (your body’s way of eliminating the excess glucose in your urine)
While rare, there are several potential side effects of Invokana that the drug’s manufacturer notes.
Lower limb amputations
According to a study, Invokana was associated with an increased risk of lower limb amputation compared to a placebo.
The most common cause of amputations among people with diabetes is chronic high blood sugar.
Invokana’s manufacturer recommends considering your history, such as:
- A history of prior amputation
- Peripheral vascular disease
- Neuropathy
- Diabetic foot ulcers
To help reduce the risk of lower limb amputations, you should practice good diabetic foot care and monitor for signs of infection (including osteomyelitis), new pain or tenderness, sores, or ulcers involving the lower limbs.
Ketoacidosis
DKA is a dangerous condition where blood sugar levels are too high and requires prompt medical attention.
According to Invokana’s manufacturer, in a study where patients with type 1 diabetes took Invokana, the rate of diabetic ketoacidosis (DKA) was increased compared to the placebo.
However, it’s important to note that Invokana isn’t meant to treat type 1 diabetes, and DKA primarily impacts people with type 1 diabetes.
Volume depletion
Taking Invokana might reduce the liquid portion of your blood (volume depletion), which can cause low blood pressure.
You might also develop an acute kidney injury from volume depletion, and your risk of volume depletion from Invokana is higher if you have kidney problems or are taking loop diuretics (a type of blood pressure medication).
Urosepsis and pyelonephritis
Serious urinary infections have been reported in patients receiving SGLT2 inhibitors, including Invokana.
Watch out for signs of these serious infections, including:
- Pain near your kidneys (on the lower sides of your back).
- Nausea with or without vomiting
- Extreme fatigue
- Reduced urine volume or no urine
- Trouble breathing or rapid breathing
- Confusion or brain fog
- Unusual anxiety levels
- Changes in heart rate, such as palpitations or a fast heartbeat
Low blood sugar (hypoglycemia)
While low blood sugar isn’t expected from taking Invokana alone, using Invokana along with insulin or sulfonylureas can increase your risk of low blood sugar.
You might need to reduce your dose of insulin or sulfonylureas if you begin taking Invokana.
Watch out for signs of low blood sugar, such as:
- Fast heartbeat
- Shaking
- Sweating
- Nervousness or anxiety
- Irritability or confusion
- Dizziness
- Hunger
Necrotizing fasciitis of the perineum (Fournier’s Gangrene)
While very rare, there is a chance of developing an infection of your perineum, the skin between your genitals and rectum, from taking SGLT2 inhibitors like Invokana.
Necrotizing fasciitis of the perineum would require prompt treatment with antibiotics, surgery, and discontinuation of Invokana if it occurred.
Genital mycotic infection
While mycotic infections are more prevalent in women taking Invokana, they can also occur in men, especially uncircumcised men or those with a history of genital infections.
Hypersensitivity reactions
If you’re sensitive to Invokana, you might develop symptoms like angioedema (swelling under the skin) or anaphylaxis (a life-threatening allergic reaction).
Bone fracture
Increased risk of bone fracture has been observed in patients taking Invokana. You and your healthcare provider should discuss your risks of bone fracture before starting Invokana.
Are there any long-term side effects of Invokana?
If you experience the more common side effects of Invokana (which are more minor), then you’re unlikely to develop any long-term side effects from taking Invokana. These side effects will dissipate if you stop taking Invokana, so they aren’t likely to linger long-term.
However, if you experience any of the rare side effects, you could have long-term side effects. Examples of long-term side effects could include complications from bacterial perineal infections and bone fractures (both rare).
How long do side effects last?
Side effects of Invokana will generally be the most severe once you begin taking it and after any increases in dose.
Medication side effects usually go away after your body gets used to your long-term dose, but you might also experience side effects the entire time you take the medication.
In general, most side effects decrease in severity after the first several weeks of taking a new medication.
How to reduce the side effects of Invokana
You can help reduce the side effects of Invokana by:
- Taking it as prescribed.
- Increasing your dose slowly, as directed by your healthcare provider.
- Practicing good urinary health habits (e.g., wiping front to back, emptying your bladder after having sex, etc.) while on Invokana.
- Drinking plenty of water (helps to flush out bacteria that can cause UTIs).
Who should not take Invokana?
Invokana might not be a suitable option for everyone. So who shouldn’t take Invokana?
- Women who are pregnant or plan to become pregnant – Invokana is especially not recommended during the second and third trimesters.
- Women who are breastfeeding.
- People under the age of 18 (the safety and effectiveness of Invokana haven’t been established in this age group).
- People aged 65 and older are at increased risk of adverse reactions related to volume depletion. In addition, blood sugar improvements were less significant in older people (75 years and older), so the pros and cons of using Invokana should be discussed among older patients and their healthcare providers.
- If you have a severe hepatic (liver) impairment, Invokana isn’t recommended.
- Patients with moderate renal impairment might not benefit from Invokana. If you have a GFR (a measure of kidney function) from 30-49, Invokana might not be the best treatment option. Invokana isn’t recommended for patients with end-stage renal disease on dialysis.
Are there any side effects of stopping Invokana?
If you stop Invokana, any side effects you were experiencing from it will start to go away.
If you stop taking Invokana and aren’t taking another diabetes medication in its place, then you might experience symptoms of high blood sugar.
Keep in mind that having high blood sugar often doesn’t have any symptoms, so you should monitor your blood sugar levels after stopping Invokana.
Signs of very high blood sugar levels can include:
- Increased thirst
- Dry mouth
- Increased urination
- Increased hunger
- Fatigue
- Vision changes
- Unintentional weight loss.
- Recurrent infections
Otherwise, you aren’t likely to experience side effects from stopping Invokana.
Conclusion
The most common side effects of Invokana are female genital mycotic infections (e.g., yeast infections), increased urination, and increased urinary tract infections.
While rare, several potential serious outcomes have been observed in patients taking medications such as Invokana.
You should discuss your risk of these conditions with your healthcare provider. If you’re prescribed Invokana, remember that it’s because the perceived benefits outweigh the potential risks.
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