Invokana (Canagliflozin) is used along with diet and exercise, and sometimes with other medications, to lower blood sugar levels in patients with type 2 diabetes (condition in which blood sugar is too high because the body does not produce or use insulin normally). Canagliflozin is in a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. It lowers blood sugar by causing the kidneys to get rid of more glucose in the urine. Canagliflozin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may develop if high blood sugar is not treated). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.

Canagliflozin comes as a tablet to take by mouth. It is usually taken once a day before breakfast or the first main meal of the day. Take canagliflozin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take canagliflozin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of canagliflozin and gradually increase your dose. Canagliflozin controls type 2 diabetes but does not cure it. Continue to take canagliflozin even if you feel well. Do not stop taking canagliflozin without talking to your doctor.

Before taking canagliflozin,

• tell your doctor and pharmacist if you are allergic (rash, hives, swelling of your face, lips, tongue, or throat, or difficulty breathing) to canagliflozin, any other medications, or any of the ingredients in canagliflozin tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Zestoretic), moexipril (Univasc, in Uniretic), perindopril (Aceon, in Prestalia), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); angiotensin receptor blockers such as azilsartan (Edarbi, in Edarbyclor), and any others not listed here. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you are on dialysis and if you have or have ever had kidney disease. Your doctor may tell you not to take canagliflozin.
• tell your doctor if you regularly drink alcohol or sometimes drink large amounts of alcohol in a short time (binge drinking), or are on a low sodium diet. Also, tell your doctor if you have or have ever had low blood pressure, urinary tract infections or urinary problems, pancreatic disease including pancreatitis (swelling of the pancreas) or have had surgery on your pancreas, yeast infections in the genital area, osteoporosis (a condition in which the bones become thin and weak and break easily), or liver disease. If you are male, tell your doctor if you have never been circumcised.
• Tell your doctor if you are eating less due to illness, surgery, or a change in your diet or if you are unable to eat or drink normally due to nausea, vomiting, diarrhea, or if you become dehydrated from being in the sun too long
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking canagliflozin, call your doctor.
• alcohol may cause a change in blood sugar. Ask your doctor about the safe use of alcoholic beverages while you are taking canagliflozin.
• you should know that canagliflozin may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. If you have this problem, call your doctor. This problem is more common when you first start taking canagliflozin. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• ask your doctor what to do if you get sick, develop an infection or fever, experience unusual stress, or are injured. These conditions can affect your blood sugar and the amount of canagliflozin you may need.

This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms. Canagliflozin may cause side effects:

• urinating a lot, including at night
• increased thirst
• constipation
• dry mouth

Tell your doctor if any of these symptoms are severe or do not go away.

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• frequent, urgent, burning, or painful urination
• a decrease in amount of urine
• urine that is cloudy, red, pink, or brown
• strong-smelling urine
• pelvic or rectal pain
• (in women) vaginal odor, white or yellowish vaginal discharge (may be lumpy or look like cottage cheese), or vaginal itching
• (in men) redness, itching, or swelling of the penis; rash on the penis; foul smelling discharge from the penis; or pain in the skin around the penis
• loss of muscle tone; weakness or heaviness in legs
• lack of energy
• cold, gray skin
• irregular or slow heartbeat

If you experience any of the following symptoms, stop taking canagliflozin and call your doctor immediately or get emergency medical treatment:

• rash; hives; itching; difficulty swallowing; swelling of the face, throat, tongue, lips, mouth, or eyes; hoarseness

If you experience any of the following symptoms of ketoacidosis, stop taking canagliflozin and call your doctor immediately or get emergency medical treatment. If possible, check for ketones in your urine if you have these symptoms, even if your blood sugar is less than 250 mg/dL:

• nausea; vomiting
• stomach-area pain
• tiredness
• difficulty breathing

Canagliflozin may increase the chance of having a fracture (broken bone), particularly in the upper arms, wrists, or hands. Talk to your doctor about the risks of taking this medication. Canagliflozin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Q: Why is Invokana prescribed?

A: Invokana is an oral diabetes medicine that helps control blood sugar levels. 

Q: Does Invokana have a generic alternative?

A: Currently there is no generic available for Invokana.

Q: What if I miss a dose of Invokana?

A: Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Q: How should I store this medication?

A: Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).