Invokana Generic Name & Formulations
Mechanism of Action
Limitations of Use
Not recommended to improve glycemic control in type 1 diabetes. Not recommended in adults with T2DM with an eGFR <30mL/min/1.73m2.
Invokana Dosage and Administration
Take before first meal of the day. eGFR ≥60mL/min/1.73m2: initially 100mg once daily; may increase to max 300mg once daily for additional glycemic control. eGFR 30–<60mL/min/1.73m2: max 100mg once daily. eGFR <30mL/min/1.73m2: do not initiate, however with albuminuria >300mg/day: may be continued at 100mg once daily (for reducing risk of ESKD, doubling of serum creatinine, CV death, and hospitalization for HF). Concomitant UGT inducers (eGFR ≥60mL/min/1.73m2): increase to 200mg once daily in patients currently tolerating 100mg, max 300mg once daily; (eGFR <60mL/min/1.73m2): increase to max 200mg once daily in patients currently tolerating 100mg once daily.
Invokana Boxed Warnings
Assess renal function prior to starting and as clinically indicated. Prior to initiation, assess and correct volume status in those with renal impairment, elderly, or on loop diuretics; monitor during therapy. Precipitating conditions for diabetic ketoacidosis (acute febrile illness, reduced caloric intake, ketogenic diet, surgery, insulin dose reduction, volume depletion, and alcohol abuse). Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue and evaluate if suspected, and treat if confirmed. Withhold (at least 3 days), if possible, prior to major surgery or procedures associated with prolonged fasting. Increased risk for lower limb amputations; monitor for infection, new pain or tenderness, sores or ulcers in lower limbs, and discontinue if occur. Consider risk factors that may predispose to amputations prior to initiation (eg, prior amputation, peripheral vascular disease, neuropathy, diabetic foot ulcers). Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Monitor for genital mycotic infections, UTIs (including urosepsis, pyelonephritis); treat if indicated. Discontinue if hypersensitivity reactions occur; treat and monitor until resolved. Consider bone fracture risks before initiation. Renal impairment. Severe hepatic impairment: not recommended. Pregnancy (during 2nd & 3rd trimesters), nursing mothers: not recommended.
Absolute bioavailability: ~65%.
Volume of distribution: 83.5 L. Plasma protein bound: 99%.
Antagonized by UGT inducers (eg, rifampin, phenytoin, phenobarbital, ritonavir): see Adult dose. Concomitant digoxin: monitor. May need a lower dose of concomitant insulin or insulin secretagogue (eg, sulfonylurea) to reduce risk of hypoglycemia. May antagonize serum lithium concentrations; monitor levels more frequently. May result in false (+) urine glucose tests or unreliable measurements of 1,5-AG assay; use alternative methods to monitor glycemic control.
Invokana Adverse Reactions
Female genital mycotic infections, UTIs (may be serious), increased urination; lower limb amputation, hypotension, ketoacidosis (may be fatal), acute kidney injury, hypoglycemia, bone fractures; rare: Fournier's gangrene.
Invokana Clinical Trials
Invokana Patient Counseling