Invokana (Canagliflozin)

Invokana, an SGLT2 inhibitor, is used to improve glycaemic control and reduce complications in type 2 diabetes and related cardiovascular or renal conditions.

• Type 2 diabetes mellitus: lowers blood glucose and HbA1c as an adjunct to diet and exercise.
• Cardiovascular risk reduction: decreases incidence of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease.
• Diabetic kidney disease: slows progression of renal decline in patients with type 2 diabetes and albuminuria.

• Canagliflozin selectively inhibits the sodium‑glucose co‑transporter‑2 (SGLT2) located in the proximal renal tubules. By blocking this transporter, it reduces reabsorption of filtered glucose, leading to increased urinary glucose excretion. The resulting loss of glucose lowers plasma glucose concentrations, improves glycaemic parameters, and contributes to modest reductions in body weight and blood pressure. These effects collectively aid in long‑term metabolic control and provide cardiovascular and renal protective benefits observed in clinical trials.

Common and serious adverse reactions associated with canagliflozin are reported in clinical use.

Common Side Effects

• Genital mycotic infections: increased incidence of yeast infections in both men and women.
• Urinary tract infection: symptoms such as dysuria, frequency, and urgency.
• Increased urination (polyuria): due to osmotic diuresis from glucose excretion.
• Thirst and dehydration: resulting from fluid loss.

Serious or Rare Side Effects

• Diabetic ketoacidosis: may occur with normal or mildly elevated blood glucose.
• Acute kidney injury: sudden decline in renal function, especially with volume depletion.
• Severe hypotension: marked blood pressure drop, particularly in patients on diuretics.
• Fournier’s gangrene: rare necrotizing infection of the perineal region.

Key safety considerations for canagliflozin include patient assessment and monitoring before and during therapy.

• Renal function assessment: evaluate eGFR before initiating and periodically thereafter.
• Volume status monitoring: watch for dehydration or hypotension, especially in the elderly or diuretic users.
• Genital infection vigilance: counsel patients on hygiene and early signs of infection.
• Cardiovascular risk evaluation: consider benefits versus risks in patients with established CVD.
• Concomitant medication review: adjust doses of insulin or sulfonylureas to avoid hypoglycaemia.
• Store below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Canagliflozin may interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Co‑administration with other SGLT2 inhibitors: risk of additive glucose loss and dehydration.
• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce canagliflozin exposure.
• Concurrent use with insulin or sulfonylureas at high doses: increased risk of severe hypoglycaemia.

Moderate Interactions (Monitor Closely)

• Loop or thiazide diuretics: monitor blood pressure and volume status.
• ACE inhibitors or ARBs: observe renal function and potassium levels.
• NSAIDs: may affect renal perfusion, requiring renal function checks.