How Invokana Works: New Type 2 Diabetes Drug Hailed as a Major Treatment Advance

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Approval of Invokana, new kind of type 2 diabetes drug, by the U.S. Food and Drug Administration means diabetics have a significant new tool for treating the disease, as well as for losing weight and improving their overall health.

“It’s not hype to say that this is a new class of drug that could provide patients with a lot of beneficial results,” Dr. Zachary Bloomgarden, Clinical Professor in the Department of Medicine, Division of Endocrinology at Mount Sinai School of Medicine and a nationally renowned diabetes educator and lecturer, said about the approval of the new drug, canagliflozin, which will be sold under the brand name Invokana. “The bottom line with this drug is that it controlled blood sugar levels without causing weight gain and caused almost no hypoglycemia. This drug could be the backbone of new treatments for type 2 diabetes.”

How Invokana Works

In development for the last 13 years, Invokana employs a “novel mechanism of action” to lower blood sugar in type 2 diabetics, Bloomgarden says. The medication is a sodium glucose co-transporter 2 (SGLT2) inhibitor, according to the drug’s developer Janssen Pharmaceuticals, Inc., a part of Johnson & Johnson.

Invokana works by inhibiting sodium glucose co-transporter 2, a carrier that aids in the reabsorption of glucose into the bloodstream through the kidneys, which occurs during the process in which blood is filtered through the kidneys. The excess glucose is then flushed out of the body, which is why Invokana also acts as a “potent diuretic,” Bloomgarden said.

“One of the most basic biological factors driving the diabetes and obesity epidemics is that our bodies have evolved to never waste food and energy,” medical journalist Alasdair Wilkins said when describing how Invokana works. “For most species, including our hunter-gatherer ancestors who could never be entirely sure where their next meal would come from, such aggressive conservation of energy made perfect sense. But modern humans live in an era of plentiful food, where there’s far greater danger of eating too much rather than too little. SGLT-1 and SGLT-2 evolved to prevent the loss of seemingly vital sugar by transporting glucose from the kidney back into the body’s circulation, with SGLT-2 reabsorbing 90% of glucose in the kidney and SGLT-1 accounting for the final 10% in the kidney.”

Invokana reduced the A1c of type 2 diabetics more effectively than glimepiride, or Amaryl, which works by increasing insulin production in the pancreas, according to Jimmy Ren, Ph.D., of Janssen Pharmaceuticals. It also worked with about the same effectiveness as sitagliptin, or Januvia, which inhibits enzymes and increases pancreatic function, Ren added.

Invokana Side Effects, Weight Loss

Because Invokana is such a powerful diuretic, it can help lower a person’s systolic blood pressure, which made some clinical trial subjects feel dizzy and even faint in the first three months while taking the drug. For extended periods, however, reducing blood pressure in a population of patients with typically higher than normal blood pressure as a result of their diabetes is a positive side effect.

Additionally, because Invokana blocks absorption of glucose, it could reduce a person’s weight. According to Janssen Pharmaceuticals, clinical trials subjects taking the drug experienced a 3 percent weight loss compared to subjects taking a placebo.

This method of reducing blood sugar by blocking glucose absorption in the kidneys proved safe and effective through nine clinical trials involving 10,285 participants, according to Janssen Pharmaceuticals. The most common side effects experienced were vaginal yeast infections and urinary tract infections, according to the company.

Invokana Cautions

Even though the FDA voted 10 to five to approve Invokana, the jury is still partially out on the drug’s complete safety and the long-term effects of the new class of medication. A drug called dapagliflozin, from Bristol-Myers Squibb and AstraZeneca, that also works as a SGLT2 inhibitor, for instance, was rejected for approval by the FDA in 2012 because of concerns it increased rates of bladder and breast cancers in subjects.

The FDA said they are requiring Janssen Pharmaceuticals to conduct “five post marketing studies for Invokana:

  • a cardiovascular outcomes trial;
  • an enhanced pharmacovigilance program to monitor for malignancies, serious cases of pancreatitis, severe hypersensitivity reactions, photosensitivity reactions, liver abnormalities, and adverse pregnancy outcomes;
  • a bone safety study;
  • and two pediatric studies under the Pediatric Research Equity Act (PREA), including a pharmacokinetic and pharmacodynamic study and a safety and efficacy study.”


Should I Take Invokana?

Even though Invokana is a creative and apparently effective new way of reducing blood sugar, Bloomgarden says that metformin, or Glucophage is, and will most likely remain, the primary drug for treating type 2 diabetes. However, Invokana can be taken by those already taking metformin and other medications, according to the FDA.

“Invokana has been studied as a stand-alone therapy and in combination with other type 2 diabetes therapies including metformin, sulfonylurea, pioglitazone, and insulin,” the agency said. The agency also said there are those who cannot and should not take Invokana.

“Invokana should not be used to treat people with type 1 diabetes; in those who have increased ketones in their blood or urine (diabetic ketoacidosis); or in those with severe renal impairment, end stage renal disease, or in patients on dialysis.”

The FDA said Invokana can be used in conjunction with other drugs, such as metformin, in patients as long as they do not have suffer from any kidney function impairment.

Patients won’t have to wait long to get their hands on Invokana if their doctor prescribes it for them. According to company spokesperson Christina Holden, Invokana is already being manufactured and field sales agents are already taking order from doctors. Financial analysts are predicting that the drug will bring in more than $100 million in sales this year and top out at more than $660 million in annual sales by 2016.

Alex O’Meara is a regular contributor to ASweetLife. He writes the blog The Other Side of Diabetes.

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Comments (22)

  1. charles walker at

    wound up with medical, (live in California) and medical wont pay for this medication citing it is to expensive. so look where that leaves me.

  2. Marc at

    I feel bad for the commentator before me. I have terrific insurance and so this drug costs me $35 a month instead of the $350 retail price. Boy does it work. I pee a ton but my A1C is way down, I feel terrific and am losing weight. My energy feels way up and I am sleeping better. No serious side effects other than having to drink a lot of water. Not a bad thing.

  3. Deb Anderson at

    I am taking Invokana alone, as I am allergic to all othet medications for type 2 diabeties it works well keeping my sugars controlled, just have to drink a lot of water, but that is ok.

  4. David at

    I’ve been taking Invokana for a week now and it isn’t working for me. My blood sugar is actually going up and never been this high. Anyone else ever have that happen.

  5. Bill at

    Just started with Invokana about 2 weeks now (taking in addition to other type 2 meds and have seen a considerable drop in blood sugar readings. Had some cautions since it was relatively new but excited about what I’m seeing.

  6. Jennifer at

    My doctor just prescribed this to me because Metformin alone isn’t working. With the prescription she gave me a card to give to the pharmacy, now I get a year for free. I’m so excited about this and really hope it works.

  7. CONNIE at


  8. William at

    I’ve been on Invokana for 3 weeks and it’s working great!
    My blood sugars are approximately between 8.0 and 8.5.
    After I eat breakfast and take my blood sugar two hours after eating it is actually lower than when I take it first thing in the morning before I take my medications.
    I find I have more energy now and I’m sleeping a lot better.
    I know that the price of this medication is high in cost but I really feel if it works for me which it is my life is more important to me than the money.

  9. Beth at

    This medicine did not work for me. I am following diet very carefully and A1c went fron 7.6 to 7.8 in three months. Tryglicerides fron 265 to 435. Blood pressure meds were cut in half. It seems the duretic portion is much stronger than the part to make you lose sugar

  10. Jennifer at

    I’ve been on Invokana for 3 months. Works. Great for me. My sugars have never been.this low except for about 2 yrs ago. Only things I get are constantly urinating and unfortunately yeast infections. I’ve Strasbourg 14 lbs awesome. Please I’d like to keep with anyone thank you!!!

  11. Ed at

    Have been taking Invokana 100 mg for 4 weeks now and have just started to have cramps and diarrhea every day. Also have had this effect from other diabetes drugs. I cannot deal with this as I drive a bus. It did lower my counts though. Looks as though I will have to stop this drug.

  12. Susan at

    Am about to start taking Invokana. I already take slow and fast acting insulin plus metformin. Will give updates on how it goes.

  13. Natasha at

    I’ve been on insulin for a year now and I’ve gain 14lbs. My insurance switch so I’m now seeing another Doctor who wants to start me on invokana and metformin. I’m kinda scared to start it , any advise ????

  14. Rick at

    I have been on Invokana for 1 week now and have had the best results I have had in 2 years. I take Lantus 20 daily. I was switched to Invokana after I had a seriously bad reaction with Toujeo ugh it didn’t work for me.

  15. Steven at

    For those of you saying things like “This doesn’t work for me, it only dropped my sugars from high 300’s to 200’s” ummm sounds like it’s working to me. If you read they clearly say that patients can expect a drop of 70~100 or more. So if your dropping from the high 300’s to 200’s, now you just have to find WHAT to use with it. I just started taking Inovaka a about a week ago and I also take 20units of Levemir before bed and I’ve dropped form like mid 400’s to 150 on average. The highest I’ve seen on a random BG draw is 169, with an average of 150. Now if I check right after I eat, I might see like 250~300 but if I eat and wait like 2 hours and check, its back down in the 150 range normally. Looking to to me so far other than I’ve gotten dizzy a few times for a couple seconds and I checked, my sugars were not too low.

  16. starr gillespie at

    I started taking ivokana and it works well for me. The price stops me from purchasing it. Can anyone suggest anything. I am a veteran and the VA. Doesn’t carry it

  17. Jackie at

    Been on Invokana for a week. Only seeing a rise in my blood sugars (from 5-6 to 8-9) and I feel shaky all the time – like I’m very low. Guess it doesn’t work for everyone. Does anyone have any insight to why it works for some and not for others?

  18. Guyzee at

    I’ve just started my invokana and I feel great !… I’ll let you know my results after a few months. Looking forward to a better future ?

  19. Janice at

    I’ve been taking Invokana for about 3 months now. I was taking Metformin only, but when it alone wasn’t controlling my glucose level my doctor put me on glimepiride. Because I was getting dangerously low readings on the glimepiride, I decided to get a referral to an endocrinologist. My doctor put me on Invokana and also gave me a card so I can get a year’s free supply.

    I can’t tell how much of my positive result was caused by Invokana and how much to attribute to Weight Watchers. I think, but don’t know, that Invokana has accelerated my weight loss. I’ve lost 28 lbs since Jan 30. This is a loss of more than 10% of my total body weight. My a1C is down from 6.9 to 6.2 and my liver enzymes (AST, ALT) are now normal. My albumin level has also dropped to normal. My systolic blood pressure has dropped to below 120. Invokana has certainly helped and I will continue to take it until I no longer need it for control.

  20. Stacey Alger at

    I have been taking Invokana for 2 months now after struggling for 2 years to get my blood sugars under control. I was constantly running in the mid 200 to 300 range. My doctor tried several different insulin and finally two months ago she decided to try Novalog short/long lasting and Invokana. Two months ago my A1c was 12.7!! Happy to say last week my number is down to 8.3 !! My blood sugars are 85-150. Yes you pee-ALOT. Yes, you have to be aware of lows. Yes, you need to drink alot if water. But its all worth it because this is the best I have felt in years! And I lost 10 pounds.

  21. tara at

    I was prescribed Invokana for my diabetes. It works really well for me – but with terrible side effect – yeast infection, UTI, constant itching and burning, etc. I now take it with the Lady Soma Candida Cleanse because it takes those symptoms away. My endocrinologist confirmed that the Lady Soma Candida Cleanse is safe to use.

  22. Freddie at

    Is being like 3 weeks that I was told in the Emergency room that I have diabetes type 2. Grr very scary at my age. So I consult my Doctor after being overnight in the emergency BC the meter was reading HI. She put me on metformin twice a day once in the and once pm both after meals. After trying n trying I was having the same numbers 200 up n 300 up so she change it for 2 metformin after breakfast and 1 after dinner, another week and my #s are still the same. Now having a cold symptoms my #s are worse. So 3 weeks later and tomorrow I will try Invokana before breakfast and metformin after. Hopefully I can get this #s under control and also my a1c.

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