Leslie just heard that Invokana can cause amputations.  She panicked.  Leslie has been on Invokana (generic: canagliflozin) for almost 2 years now.  She looks at her feet and smiles "they are still there".  Okay, Leslie is a little dramatic but in reality, people get exposed to all sorts of information.  Most of the time they do not know which information is correct.

Questions that most commonly get in my diabetes clinic are the following: What are Invokana side effects?  Does Invokana cause weight loss?  Does Invokana cause amputations?  Does Invokana cause infections?  Is Invokana expensive?  Is there an Invokana coupon?  The questions can go on and on.  In this article, if you will find all the answers to your questions about Invokana. In this article you will learn everything about Invokana including all of the Invokana side effects.

What is Invokana (generic: canagliflozin)?

Invokana is a medication designed for patients with diabetes. The generic name of Invokana is canagliflozin and is very similar to Jardiance and Farxiga in terms of the way it works.  Invokana is used when metformin and lifestyle changes are not enough to control diabetes.  It belongs to a class that is called SGLT2 inhibitors.

SGLT2 is a receptor that reabsorbs the sugar from the kidneys back to the bloodstream. Invokana on the other hand blocks that receptor.  This allows the sugar to go up toward the kidney without being reabsorbed to the blood.  This results in sugar loss in the urine.  As a result blood sugars go down. Leslie heard that Invokana can cause weight loss.  She asks her endocrinologist whether that is true and whether that is a good or bad  Invokana side effect.

Is Invokana expensive and are there coupons/co-pay cards for Invokana?

The price of Invokana is similar to other branded oral agents.  It can cost around $500 for a month's supply.  If your insurance covers it and if you use a co-pay card your cost can be dramatically reduced to as little as $10-$20.  So, if you are not provided an Invokana coupon you need to ask the prescribing doctor to provide you one.  In the following sections, we will also give a few tricks on how to correctly use Invokana coupons.

Does Invokana cause weight loss?

One of the good side effects of Invokana (generic: canagliflozin) is weight loss.  Patients on Invokana can lose up to 300 calories a day. Leslie decided to give Invokana a try and went to the pharmacy.  She was surprised by the $200 bill she has to pay for Invokana since it’s branded.  She calls SugarMDs for help.  As a patient of SugarMDs she gets help immediately.

Does Invokana cause amputations?

In some studies, but not all, increased risk of amputations was reported. So is amputation is one of Invokana side effects?  Patients who had amputations were patients who typically had significant neuropathy and vascular problems.  When you have neuropathy you tend to lose the pain sensation on your feet.  Especially at the bottom of your feet.  Patients who have also had amputations also had underlying vascular disease.

Definitely having vascular disease and having neuropathy is not a good combination.  That is because if you have a lesion or an ulcer you may not even realize until it is very large.  This occurs due to neuropathy.  The wound may not heal because of vascular insufficiency.

So if you have underlying neuropathy and vascular disease Invokana may reduce the blood flow to the wound site.  This can potentially delay the healing and increased risk of gangrene. If gangrene happens, amputation risk may go up.  So, my advice is to make sure that you keep an eye on the bottom of your feet.  Check the bottom of your feet twice a week, on a regular basis. This advice is valid regardless of you being on Invokana.  So, you will not have any amputations unless you have a non-healing ulcer that turns into gangrene.  Also, if you have an ulcer, you will need to stop Invokana and take care of it immediately.

What is the dosing information for Invokana?

Invokana comes in 100 mg and 300 mg dose. The starting dose is typically 100 mg a day. Depending on your response your diabetes specialist may increase the dose to 300 mg. Make sure to request an Invokana coupon from your physician if you have any insurance plan that is not Medicare or Medicaid. Invokana coupons can bring your co-pay significantly down. At SugarMDs we provide coupons for our patients and make sure that they can utilize the coupon.

Is Invokana good for the kidneys or can Invokana cause harm to the kidneys?

Studies indicate that Invokana (generic: canagliflozin) can actually reduce the progression of chronic kidney disease quite significantly.  In some studies this is up to 40%.  On the other hand, Invokana can cause dehydration if the patient does not keep up with fluid requirements.  So I always recommend my diabetic patients who are on Invokana to stay hydrated at all times.  That is because dehydration can worsen kidney function temporarily. 

So, I would not consider kidney failure as an Invokana side effect unless a patient is dehydrated. Invokana also has a special indication for patients with low kidney function.  Meaning that Invokana can be used in patients with low kidney function.  This is now in their label and approved by the FDA.  As of February 2020, Jardiance and Farxiga do not have that indication. For patients with liver problems, no dose adjustment is necessary with Invokana.

Most common side effects of Invokana

Genital infections of Invokana (generic: canagliflozin) as a side effect

Up to 10% of women and up to 5% of men can develop a genital infection.  Most commonly fungal infections occur.  Urinary tract infections can also happen.  When you have a fungal infection you may notice discharge and itchiness in the genital area. 

Urinary tract infection typically gives pain during urination, urgency to urinate or increased frequency of urination.  There may be pain in the bladder area as well.  If you have this side effect of Invokana please call your doctor to get an antifungal or antibacterial medication.

Low blood pressure side effect of Invokana

Especially elderly patients may be at risk for low blood pressure.  If your blood pressure is not high to begin with Invokana can reduce your blood pressure too low.  You may feel fatigued or dizzy because of Invokana.  If you feel this side effect of Invokana you should immediately report to your doctor.  Your doctor may possibly change other blood pressure medications you are on. If you are on other water pills Invokana can increase your risk of dehydration.

Low blood sugar

Invokana by itself does not cause low blood sugar.  But if you are on insulin Invokana can increase your risk of low blood sugar as a side effect.  Glipizide, glyburide and glimepiride can also increase your risk of low blood sugar when you are on Invokana.

Gastrointestinal side effects of Invokana (generic: canagliflozin) 

Rarely Invokana can cause abdominal pain, constipation, diarrhea. Like any other medication, allergic reactions can also happen with Invokana as a side effect. Occasionally Invokana can also increase your hemoglobin due to dehydration. 

There are rare reports of diabetic ketoacidosis related to Invokana Jardiance or Farxiga.  If you have fruity breath, nausea, vomiting abdominal pain please report to your doctor immediately. Finally, as we discussed in the presence of vascular insufficiency and neuropathy Invokana can increase the risk of amputations.

Does Invokana cause heart attacks?

That is a good question.  Many studies actually proved the opposite.  Invokana reduces the chances of dying from heart attacks.  It reduces the number of heart attacks in patients taking Invokana.  Invokana can increase the LDL slightly but that does not really cause any cardiovascular problem.

Does Invokana cause bone fractures as a side effect?

There are mixed results from the studies when it comes to this.  It is not clear if the increased bone fractures found in the studies are due to low blood pressure and increased risk of falls in the elderly or due to the direct effect of Invokana on the bone.  Some studies also did not report an increased risk of fracture.  As a result, this is a debatable topic.

Who should not take Invokana (generic: canagliflozin)?

• Patients who have frequent genital fungal or bacterial infections.
• If you have had diabetic ketoacidosis in the past.
• Patients who already have high potassium levels and difficult to control.
• Those who have severe neuropathy and/or diabetic foot ulcer.
• If you have severe kidney failure.
• Patients who have frequent falls.
• Those patients who have low blood pressure/hypotension.
• Patients with a history of amputation(s) not necessarily due to Invokana but from a diabetic foot ulcer.

Can pregnant patients or breastfeeding diabetic patients take Invokana?

The answer to that is clearly no.  Diabetic pregnant or breastfeeding patients can take metformin or other insulins. At SugarMDs, we take care of our patients.  If you have any questions about any medication you will get an honest answer from our endocrinologist. Whether you need an Invokana prescription, an Invokana coupon, curious whether Invokana causes amputations or kidney failure or want to learn about the side effects of invokana, our diabetes coach and diabetes doctors are on your side. 

If Invokana (generic: canagliflozin) is expensive we will provide you coupons.  If coupons do not work, we will find an alternative medication.  24/7 availability and expert advice for your diabetes care are what we do.  Remote diabetes monitoring helps you maintain accountability. 

We strive to find the least expensive and most effective medications for our patients. To learn more give us a call at 1-800-644-3963. Please feel free to contact us directly for any questions or concerns. Ahmet Ergin, MD, CDE, ECNU Endocrinology