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One of the novel drugs being used for the treatment of type 2 diabetes mellitus is Invokana which has proved to be quite effective for glycemic control. The drug contains Canagliflozin as its active component. Invokana is being produced by Janssen Pharmaceuticals, Inc. and was approved by the Food and Drug authority (FDA) in the year 2013.
The active component of Invokana is Canagliflozin which is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. SGLT2 is responsible for the reabsorption of the glucose that is filtered into the lumen of the tubules. Canagliflozin works by competitively but reversibly inhibiting the SGLT2 leading to decreased reabsorption of glucose from urine with a resultant decrease in the blood sugar levels1.
The drug is indicated for the treatment of type 2 diabetes mellitus as an adjunct to other antihyperglycemic agents, insulin or conservative therapy consisting of exercise and diet control. It has not been approved for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis.
Invokana is available in the form of packs, each containing 30 yellow colored capsules. The recommended dose of Invokana is 100mg per day which should ideally be taken before the first meal of day. Since the drug tends to induce tolerance, the healthcare provider may increase the dose of the drug up to 300mg per day.
Common side effects observed with the use of Invokana include
The following precautionary measures should be exercised with the use of Invokana.
Invokana causes the blood pressure to drop (hypotension) as a result of osmotic diuresis (water loss) which is why it is necessary to assess the blood volume status and the kidney functions before initiating therapy, especially in elderly patients who do not feel sufficiently thirsty to compensate for the water loss3.
Patients with reduced renal clearance (eGFR) should be administered Invokana quite carefully. In patients with mild renal impairment (eGFR of 60 mL/min/1.73 m2 or greater), no dose adjustment is needed. In people with moderate renal impairment having eGFR of 45 to less than 60 mL/min/1.73 m2, the dose of the drug should be limited to 100mg per day. In patients with severe renal impairment with an eGFR of less than 45 mL/min/1.73 m2, the drug should not be given at all.
Invokana is known to cause diabetic ketoacidosis (a life-threatening condition characterized by vomiting, abdominal cramps, excessive thirst and urination, dizziness, confusion, rapid breathing, fruit breath odor etc.) in patients suffering from type 1 diabetes mellitus. Therefore, the drug should not be administered in type 1 diabetic patients4.
Invokana use can induce hypokalemia (decreased blood potassium levels) so serum electrolytes should be closely monitored.
The renal function, especially serum creatinine, of the patients receiving Invokana should be observed vigilantly.
Concomitant use of Invokana and other anti-diabetic drugs can induce hypoglycemia so blood sugar levels must be regularly monitored in such patients.
Invokana use has been reported to lower the level of low density lipoproteins (LDLs) in the body.
Invokana is a category C drug. Animal studies have shown it to cause fetal renal impairment. It should only be used in pregnant women if its advantages outweigh the potential risks associated with it.
Lactating mothers should always inform the doctor if they are to receive Invokana.
Invokana 100g should not be used in people under the age of 18.
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Invokana is a newer antihyperglycemic agent being used for the control of blood glucose levels in patients suffering from type 2 diabetes mellitus.
Invokana contains Canagliflozin which is a sodium-glucose co-transporter 2 (SGLT2) inhibitor and works by inhibiting the reabsorption of glucose from the urine, thereby decreasing the blood sugar levels.
Always store Invokana at room temperature between 15oC to 30oC, away from direct light, heat and moisture. Keep the drug out of reach of children.
No, there is no alternative to Invokana.
The recommended dosage of Invokana is 100mg per day. One tablet should be taken with a little amount of water before the first meal of the day. Avoid drinking alcohol with the drug.
Invokana is commonly prescribed for the treatment of type 2 diabetes mellitus as an adjunct to other antihyperglycemic agents, insulin or as an add on to the conservative therapy.
Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar levels and insulin resistance. Common symptoms include excessive thirst, increased urinary frequency, unexplained weight loss, lethargy etc.
If you accidentally overdose on Invokana, report to the nearest medical facility, call your healthcare provider or call the Poison Control Center at 1-800-222-1222 right away.
If you miss a dose of Invokana, take the missed dose as soon as you remember it. However, if the time of next dose is impending, do not take the missed dose to avoid over dosage of the drug. Call your doctor if you are not sure about the missed dose schedule.
1. Haas, B., et al. "Efficacy, safety and regulatory status of SGLT2 inhibitors: focus on canagliflozin." Nutrition & diabetes 4.11 (2014): e143.
2. Nicolle LE, Capuano G, Fung A, Usiskin K. Urinary tract infection in randomized phase III studies of canagliflozin, a sodium glucose co-transporter 2 inhibitor. Postgrad Med. 2014;126:7–17
3. Elmore LK, Baggett S, Kyle JA, Skelley JW. A review of the efficacy and safety of canagliflozin in elderly patients with type 2 diabetes. Consult Pharm. 2014;29:335–346
4. Gelaye, Alehegn, et al. "Severe ketoacidosis associated with canagliflozin (Invokana): a safety concern." Case reports in critical care 2016 (2016).