Invokana (Canagliflozin Hemihydrate)

    Invokana (Canagliflozin Hemihydrate) Dosage and Side Effects

    INVOKANA is the brand name of the medicine canagliflozin, which is used to treat people with type 2 diabetes. It helps control blood sugar levels by prompting the kidneys to get rid of more glucose in the urine.

    Warnings and Precautions

    Serious Warnings and Precautions

    • Diabetic ketoacidosis (DKA) is a serious and life-threatening condition that requires urgent hospitalization. DKA has been reported in patients with type 2 diabetes mellitus (T2DM), with normal or high blood sugar levels, who are treated with INVOKANA and other sodium-glucose co-transporter 2 (SGLT2) inhibitors. Some cases of DKA have led to death.

    • Seek medical attention right away and stop taking INVOKANA immediately if you have any of the following symptoms (even if your blood sugar levels are normal): difficulty breathing, nausea, vomiting, stomach pain, loss of appetite, confusion, feeling very thirsty, feeling unusually tired, a sweet smell to the breath, a sweet or metallic taste in the mouth, or a different odour to urine or sweat.

    • INVOKANA should not be used in patients with type 1 diabetes.

    • INVOKANA should not be used to treat DKA or if you have a history of DKA.

    BEFORE you use INVOKANA talk to your doctor or pharmacist if you:

    • have type 1 diabetes (your body does not produce any insulin). INVOKANA should not be used in patients with type 1 diabetes.

    • have an increased chance of developing DKA, including if you:

      • are dehydrated or suffer from excessive vomiting, diarrhea, or sweating;

      • are on a very low carbohydrate diet; drink a lot of alcohol;

      • have/have had problems with your pancreas, including pancreatitis or surgery on your pancreas;

      • are hospitalized for major surgery, serious infection or serious medical illnesses;

      • have a history of diabetic ketoacidosis (DKA).

    • are taking a diuretic medicine also known as water pills (used to remove excess water from the body), such as furosemide; or taking medicines to lower your blood pressure such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB); or have or have had low blood pressure (hypotension). Taking INVOKANA with any of these medicines may increase the risk of becoming dehydrated and/or low blood pressure (hypotension).

    • are older than 65 years of age.

    • have kidney problems.

    • are taking medicines to lower your blood sugar such as glyburide, gliclazide or glimepiride (sulfonylureas) or insulin. TakingINVOKANA with any of these medicines can increase the risk of having low blood sugar (hypoglycemia). Take precautions to avoid the potential for low blood sugar while driving or using heavy machinery.

    • have liver problems.

    • have heart problems.

    • have intolerance to some milk sugars. INVOKANA tablets contain lactose.

    • are pregnant or are planning to have a baby. INVOKANA is not recommended for use in pregnant women.

    • are breast-feeding. INVOKANA should not be used during breast-feeding.

    • often get urinary tract infections.

    INVOKANA is not recommended for use in patients under 18 years of age.

    INVOKANA will cause your urine to test positive for sugar (glucose).

    While taking INVOKANA your doctor may order a blood test to check your kidney function, blood fat levels (Low-Density Lipoprotein cholesterol or LDL-C) amount of red blood cells in your blood (haematocrit), and potassium blood levels.

    Driving and using machines:

    INVOKANA may cause dizziness or light-headedness. DO NOT drive or use machines until you know how the medicine affects you.

    Side Effects

    These are not all the possible side effects you may feel when taking INVOKANA. If you experience any side effects not listed here, contact your healthcare professional. 

    Very common side effects (may affect more than 1 in 10 people):

    • Low blood sugar (hypoglycemia) when used with sulfonylurea (such as glimepiride, gliclazide, and glyburide) or insulin. The symptoms of low blood sugar include blurred vision, tingling lips, trembling, sweating, pale looking, a change in mood or feeling anxious or confused. You should ask your doctor or pharmacist what to do if you have any of the symptoms above.

    • Vaginal yeast infection. The symptoms include vaginal odor, white or yellowish vaginal discharge, and/or itching.

    Common side effects (may affect up to 1 in 10 people):

    • Rash or redness of the penis or foreskin (yeast infection or balanitis).

    • Urinary tract infection (burning sensation when urinating, cloudy urine, strong odor).

    • Changes in urination such as urinating more often or in larger amounts, an urgent need to urinate, and a need to urinate at night.

    • Constipation.

    • Nausea.

    • Feeling thirsty

    Uncommon side effects (may affect up to 1 in 100 people):

    • Dehydration (not having enough water in your body). The symptoms include passing out (fainting) or feeling dizzy or light-headed due to a drop in blood pressure when you stand up, have low blood pressure, very dry or sticky mouth, feeling very thirsty, weak or tired, passing little or no urine and/or fast heartbeat. Dehydration happens more often in older people (over 65 years of age) or people with kidney problems, and people taking water pills. Talk to your doctor about what you can do to prevent dehydration.

    • Rash.

    • Hives (raised red patches on the skin).

    Diabetic Ketoacidosis (DKA) is a serious medical condition with normal or high blood glucose levels. Get medical help right away if you have any of the symptoms in the table below under DKA, even if your blood glucose levels are normal. Tell your doctor if you are hospitalized for major surgery, serious infection or serious medical illness.

    Interactions with this medication

    Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This is because this medicine may affect the way INVOKANA works.

    Drugs that may interact with INVOKANA include:

    • digoxin, a medicine used to treat heart problems.

    • furosemide or other diuretics (water pills).

    • an ACE inhibitor or an ARB (to lower your blood pressure).

    • insulin or a sulfonylurea (such as glimepiride, gliclazide, or glyburide).

    • carbamazepine, phenytoin or phenobarbital.

    • efavirenz or ritonavir.

    • rifampin.

    • St. John’s wort.

    Proper Use of this medication

    Usual starting dose:

    100 mg by mouth each day with or without food. Your doctor may increase your dose to 300 mg. However, if you have a kidney problem your doctor will limit your dose to 100 mg.

    It is best to take INVOKANA before the first meal of the day and at the same time each day. Swallow the tablet whole with water.

    Overdose:

    In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

    Missed dose:

    • If you forget to take a dose of INVOKANA, take it as soon as you remember. However, if it is nearly time for the next dose, skip the missed dose and follow your usual schedule.

    • Do not take a double dose (two doses on the same day) to make up for a forgotten dose.

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    The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.