Invokana (Canagliflozin)

• Invokana (canagliflozin) is indicated for management of type 2 diabetes mellitus, an endocrine disorder affecting glucose metabolism.
• Type 2 diabetes mellitus: improves glycemic control when used together with diet and exercise.

• Canagliflozin selectively inhibits the sodium‑glucose co‑transporter 2 (SGLT2) located in the proximal renal tubules. By blocking this transporter, it reduces renal reabsorption of filtered glucose, leading to increased urinary glucose excretion and a consequent reduction in plasma glucose concentrations.

Adverse reactions may range from mild to serious, and patients should be informed of both common and rare possibilities.

Common Side Effects

• Genital mycotic infection: itching or discharge in the genital area.
• Urinary tract infection: dysuria, frequency, or urgency.
• Increased urination: polyuria and nocturia.
• Thirst: polydipsia due to osmotic diuresis.
• Mild hypotension: dizziness, especially on standing.
• Nausea: occasional upset stomach.

Serious or Rare Side Effects

• Ketoacidosis: metabolic acidosis with normal or low glucose.
• Severe dehydration: may lead to hypotension or renal injury.
• Acute kidney injury: sudden decline in renal function.
• Fournier's gangrene: necrotizing fasciitis of the perineum.
• Bone fracture: increased risk of lower‑limb fractures.
• Lower‑limb amputation: especially of the toe or metatarsal.

• Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor for potential complications.
• Monitor renal function: assess eGFR prior to start and periodically thereafter.
• Assess for ketoacidosis: educate patients on warning signs such as nausea, vomiting, abdominal pain.
• Evaluate cardiovascular risk: consider in patients with established CVD.
• Avoid in severe renal impairment: contraindicated when eGFR is below the recommended threshold.
• Review concomitant diuretics: increased risk of volume depletion and hypotension.
• Store at ambient temperature below 25°C: keep in the original pack, protect from moisture.

Canagliflozin may interact with several drug classes, requiring dose adjustments or monitoring.

Major Interactions (Avoid)

• Insulin: heightened risk of hypoglycemia.
• Loop diuretics: additive diuretic effect leading to dehydration.
• Rifampin: may reduce canagliflozin plasma concentrations.

Moderate Interactions (Monitor Closely)

• ACE inhibitors/ARBs: monitor renal function and serum potassium.
• NSAIDs: potential impact on renal perfusion.
• Thiazide diuretics: may increase volume‑depleting effects.