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Canagliflozin/Metformin

Invokamet

Invokamet is a potent combination medication prescribed for adults with Type 2 Diabetes Mellitus. It blends canagliflozin and metformin to control blood sugar effectively. Canagliflozin reduces glucose reabsorption in the kidneys, while metformin decreases liver glucose production levels and increases insulin sensitivity. Available in multiple strengths and formulations, Invokamet also helps lower the possibility of major cardiovascular events, hospitalization for heart failure & progression of kidney disease in certain patients. Taken as directed alongside meals, Invokamet supports comprehensive diabetes management by improving glycemic control and protecting against related health complications. Always follow healthcare guidance to optimize treatment outcomes.

Product Overview

Invokamet is an advanced medication designed for enhancing glycemic control in people with Type 2 Diabetes. It combines canagliflozin and metformin, targeting multiple mechanisms to lower blood sugar levels effectively. Canagliflozin, an SGLT2 inhibitor, reduces glucose reabsorption in the kidneys, promoting its excretion, while metformin decreases glucose production in the liver and boosts insulin sensitivity in muscles. This dual approach helps optimize glucose uptake.

Available in both regular and extended-release forms, Invokamet allows for flexible dosing options, ranging from 50 mg/500 mg to 150 mg/1000 mg combinations, accommodating the diverse needs of patients, whether they are new to treatment or already on canagliflozin or metformin. The typical starting dosage is 50mg/500mg twice daily, adjustable based on individual response and tolerability. Apart from managing blood sugar, Invokamet also reduces the risk of significant diabetes-related complications such as cardiovascular events, hospitalization for heart failure & progression of kidney disease, especially in those with existing heart disease and diabetic nephropathy.

Patients should take Invokamet as prescribed, ideally with meals, to reduce gastrointestinal side effects and maintain regular blood sugar monitoring. Potential side effects, including urinary and genital infections, should be aware of. Patients experiencing severe symptoms like lactic acidosis or ketoacidosis should seek immediate medical attention. Invokamet is a critical component in managing Type 2 Diabetes, helping to improve patient health and prevent complications.

What Are the Uses of Invokamet?

  • Type 2 Diabetes
  • Reduces the chances of severe cardiovascular events (such as heart attacks & strokes) in adults with Type 2 diabetes and existing heart disease.
  • Lowers the probability of hospitalization for heart failure, cardiovascular mortality & progression of kidney disease in certain adults with Type 2 diabetes & diabetic kidney disease.

What Are the Forms & Strengths of Invokamet?

Invokamet is available in various dosage forms and strengths, combining canagliflozin with metformin. Here are the specific options:

Regular Tablets:

  • 50 mg canagliflozin / 500 mg metformin
  • 50 mg canagliflozin / 1000 mg metformin
  • 150 mg canagliflozin / 500 mg metformin
  • 150 mg canagliflozin / 1000 mg metformin

Extended-Release Tablets:

  • 50 mg canagliflozin / 500 mg metformin XR (extended-release)
  • 50 mg canagliflozin / 1000 mg metformin XR
  • 150 mg canagliflozin / 500 mg metformin XR
  • 150 mg canagliflozin / 1000 mg metformin XR

What Are the Recommended Dosage of Invokamet?

Dosage for Type 2 Diabetes Mellitus

Initial Dosage:

  • Patients not previously treated with canagliflozin or metformin:
    • Invokamet: 50mg/500mg orally twice daily (BID)
    • Invokamet XR: Two tablets (50mg/500mg each) once daily (quay)
  • Patients currently on metformin:
    • Invokamet: One tablet orally BID, matching the total daily dose (TDD) of canagliflozin 100 mg with the current or closest suitable metformin dose
    • Invokamet XR: Two tablets once daily, matching TDD of canagliflozin 100 mg with current or closest suitable metformin dose
  • Patients currently on canagliflozin:
    • Invokamet: One tablet BID, matching the same daily dose of canagliflozin and metformin 1000 mg
    • Invokamet XR: Two tablets qDay, matching the same daily dose of canagliflozin and metformin 1000 mg
  • Patients on both canagliflozin and metformin:
    • Invokamet: One tablet BID, matching the same daily doses of canagliflozin and metformin
    • Invokamet XR: Two tablets qDay, matching the same daily doses of canagliflozin and metformin

Maintenance Dosage:

  • For additional glycemic control (patients with eGFR ≥60 mL/min/1.73 m^2):
    • Invokamet: For those tolerating canagliflozin 50 mg BID, increase to 150 mg BID with a gradual escalation of metformin dose based on tolerability
    • Invokamet XR: For those tolerating canagliflozin 100 mg per day, increase to 300 mg per day with a gradual escalation of metformin dose based on tolerability

Maximum Dosage:

  • Not to exceed a total daily dose of 300 mg canagliflozin and 2000 mg metformin

[Note: Remember, these recommendations may vary from person to person. Discuss it with your medical professional, and they’ll customize your dosage accordingly.]

How to Use Invokamet? 

  • Start Invokamet only on the advice of your healthcare provider. Your provider will prescribe the correct dosage based on your health condition & response to treatment.
  • Take Invokamet precisely as prescribed, typically once or twice a day with meals to lower the risk of an upset stomach.
  • Do not crush, chew, or break the Invokamet tablets. Swallow the tablet whole to ensure the medication is released correctly in the body.
  • You should take Invokamet during meals to help lessen any gastrointestinal side effects, such as nausea or an upset stomach.
  • Consistently check your blood sugar levels according to your doctor’s instructions. Invokamet doses may be adjusted based on your blood sugar test results.
  • Ensure you stay hydrated while taking Invokamet, as it can cause you to urinate more often.
  • Be aware of possible side effects such as genital infections, urinary tract infections, and increased urination. Report any severe or persistent symptoms to your healthcare provider.
  • Maintain all scheduled appointments with your healthcare provider to evaluate the effectiveness of your treatment and make necessary adjustments.

[Note: Your doctor will determine the appropriate dosage for you based on your medical condition, following established guidelines and research on the medication. Adjustments may be made over time as necessary.]

How Does Invokamet Work?

Invokamet is a combination medication used in the treatment of type 2 diabetes, containing two active ingredients: canagliflozin and metformin. Canagliflozin works by inhibiting sodium-glucose co-transporter 2 (SGLT2) in the kidneys. This inhibition prevents glucose reabsorption back into the blood, promoting the excretion of glucose through urine and thus lowering blood sugar levels. Metformin reduces glucose production levels by the liver and heightens the sensitivity of muscle cells to insulin, enhancing glucose uptake. Together, these actions help improve glycemic control, lower blood sugar levels & lower the possibilities of diabetes-related complications when diet and exercise alone are insufficient.

Important Safety Information for Using Invokamet 

What Are the Side Effects of Invokamet?

Invokamet is used to treat blood sugar levels in people with type 2 diabetes, but it can also cause several side effects. Here are some of the common side effects associated with Invokamet:

  • Urinary tract infections
  • Genital yeast infections
  • Nausea and vomiting
  • Diarrhea
  • Increased urination
  • Thirst
  • Headache
  • Abdominal discomfort

Inform your doctor immediately if you experience any of the following serious side effects:

  • Lactic acidosis: A rare yet serious condition characterized by increased lactic acid in the blood. Symptoms include muscle pain, difficulty breathing, stomach discomfort, and extreme fatigue.
  • Ketoacidosis: A severe condition where the body produces high levels of blood acids called ketones. Symptoms include nausea, vomiting, abdominal pain, and difficulty breathing.
  • Kidney problems: Including sudden kidney injury or worsening of existing kidney issues.
  • Serious urinary tract infections can sometimes lead to blood infections (urosepsis).
  • Low blood sugar (hypoglycemia): Especially when used with other diabetes medications.
  • Vitamin B12 deficiency: Long-term use can decrease vitamin B12 levels.
  • Severe joint pain
  • Increased risk of bone fractures
  • Allergic reactions: Including anaphylaxis and angioedema.
  • Increased risk of lower limb amputation, Particularly in patients with cardiovascular disease.

[Note: This enumeration may not encompass all potential side effects. Always seek guidance from your healthcare professional for advice on side effects.]

Are There Any Warnings for Invokamet? 

Invokamet is used alongside diet and exercise to improve blood sugar control levels in adults with type 2 diabetes. However, it’s associated with several serious health risks, which may be heightened in certain groups. If you have concerns, discuss alternative treatments with your healthcare provider.

  • Lactic Acidosis: Metformin in Invokamet can cause lactic acidosis, a severe condition where too much lactic acid builds up in the blood. Inform your doctor about your medical history and current medications. Reach out for immediate medical attention if you experience symptoms like difficulty breathing, stomach upset, extreme weakness or tiredness, feeling cold, or unusual muscle pain.
  • Amputation Risks: Invokamet may increase the risk of leg and foot amputations. Be vigilant for new pain, tenderness, sores, ulcers, or infections on your legs or feet, and consult your healthcare provider promptly.
  • Ketoacidosis: Some patients have developed ketoacidosis, a severe condition that makes the blood too acidic. Monitor for symptoms like dry mouth, fruity breath odor, nausea, vomiting, abdominal pain, or difficulty breathing. Seek emergency care if these symptoms occur.
  • Dehydration & Low Blood Pressure: Dehydration can lead to kidney function and blood pressure problems. Stay hydrated and report symptoms like dizziness or reduced urine output to your provider.
  • Genital and Urinary Tract Infections: These can raise the risk of severe infections that might require hospitalization. Symptoms such as frequent or painful urination, lower abdominal pain, or discomfort in the genital area should prompt you to contact your healthcare professional.
  • Hypoglycemia: Invokamet can cause low blood sugar, primarily when used with other diabetes medications. Symptoms include anxiety, shakiness, confusion, a fast heartbeat, and hunger. Monitor your blood sugar levels regularly.
  • Severe Allergic Reactions: Rarely, severe allergic reactions can occur. Symptoms include rash, hives, breathing difficulties, or swelling of the face, lips, or throat. Seek immediate medical assistance if these symptoms develop.
  • Bone Fractures: There is an elevated risk of bone fractures starting as early as three months after beginning treatment. Discuss bone health strategies with your healthcare provider.
  • Low Vitamin B12 Levels: Monitoring is essential as low levels can lead to anemia. Symptoms to watch for include low energy, muscle weakness, reduced appetite, and tingling in extremities. Routine blood tests are recommended to monitor B12 levels.

What Are the FDA Boxed Warning for Invokamet?

Invokamet carries an FDA Boxed Warning, the strongest warning the FDA requires. This warning highlights significant risks that may be associated with the medication. Here are the critical aspects of the boxed warning for Invokamet:

  • Lactic Acidosis:
    • Risk: Metformin, a key ingredient in Invokamet, can cause a rare yet severe condition known as lactic acidosis. This condition involves an accumulation of lactic acid in the blood, which can be life-threatening.
    • Symptoms: Symptoms of lactic acidosis include unusual muscle pain, extreme fatigue or weakness, difficulty breathing, significant drowsiness, abdominal pain, nausea or vomiting, chills, dizziness or lightheadedness, and a slow or irregular heartbeat.
    • Action: Patients are advised to get medical attention quickly if they experience any symptoms of lactic acidosis.
  • Lower Limb Amputation:
    • Risk: Canagliflozin, another component of Invokamet, has been associated with an elevated risk of lower limb amputations, primarily of the toe and midfoot; however, leg amputations above and below the knee have also occurred.
    • Recommendation: Patients should be monitored for signs and symptoms of infection, new pain or tenderness, sores or ulcers involving the lower limbs, and promptly evaluated if such symptoms develop.

What Are the Invokamet Precautions?

  • Allergies: Do not use Invokamet if allergic to canagliflozin or metformin.
  • Severe Kidney Disease: Avoid if you have severe kidney disease.
  • Ketoacidosis: Do not use it if you have ketoacidosis; consult your doctor for treatment instead.
  • Medical Imaging: Temporarily stop taking Invokamet if undergoing an X-ray or CT scan requiring dye injection.
  • Heart Issues: Inform your doctor if you have heart problems.
  • Diabetic Foot Complications: Report any history of diabetic foot ulcers or amputations.
  • Circulation and Nerve Problems: Disclose any circulation or nerve issues in your legs or feet.
  • Liver or Kidney Disease: Ensure your doctor knows of any liver or kidney diseases.
  • Nutritional Deficiencies: Discuss low levels of vitamin B12 or calcium in your blood.
  • Urinary Issues: Mention any bladder infections or urination problems.
  • Pancreatic Conditions: Tell your doctor about any pancreas disorders or surgeries.
  • Dietary Changes: Inform your doctor if your diet has changed or you are on a low-salt diet.
  • Lactic Acidosis Risk: Understand the risk factors for lactic acidosis, especially if you have other medical conditions, chronic alcoholism, or are 65 or older.
  • Pregnancy: Notify your doctor immediately if you become pregnant; canagliflozin may harm the baby if taken during the second or third trimester.
  • Ovulation Stimulation: Be aware that metformin may stimulate ovulation, increasing the risk of unintended pregnancy.
  • Breastfeeding: Do not breastfeed while using Invokamet.
  • Age Limitation: Invokamet is not approved for use by anyone under 18.

What Are the Contraindications of Invokamet? 

Invokamet has specific contraindications where its use should be avoided because of the potential risk for severe adverse effects or interactions. Here are the critical contraindications for Invokamet:

  • Renal Impairment or Disease:
      • Invokamet is contraindicated in patients with severe renal impairment (eGFR below 30 mL/min/1.73 m²), end-stage renal disease, or patients on dialysis due to the risk of lactic acidosis from metformin accumulation.
  • Metabolic Acidosis, Including Diabetic Ketoacidosis:
      • Invokamet should not be used in patients with metabolic acidosis, including diabetic ketoacidosis (a severe complication of diabetes).
  • Hypersensitivity:
      • Invokamet is contraindicated in patients with hypersensitivity to canagliflozin, metformin, or any of the formulation’s excipients. Hypersensitivity reactions may include anaphylaxis, angioedema, rash, or urticaria.
  • Liver Disease:
    • While not explicitly contraindicated, caution is advised when using Invokamet in patients with liver impairment due to the potential risk of lactic acidosis from metformin.

What If You Missed a Dose of Invokamet?

  • If you remember the missed dose soon after it was due, take it as soon as you remember.
  • If it’s almost time for your next scheduled dose, drop the missed dose. Do not take a double dose of Invokamet to compensate for the missed one.
  • Continue with your regular dosing schedule after missing a dose to maintain consistent medication levels in your body.
  • Pay close attention to your blood sugar levels after missing a dose, as fluctuations may occur.
  • If you frequently miss doses, discuss this with your healthcare provider. They may offer tips or tools to help you remember your medication.

[Note: If you have missed a dose of Invokamet and are unsure when to take the next one, immediately consult your healthcare professional or pharmacist.]

What Happens If You Take Too Much of Invokamet?

Taking too much Invokamet can lead to serious health complications. Here’s what could happen if you overdose on Invokamet:

  • Hypoglycemia (Low Blood Sugar): Since Invokamet helps to lower blood sugar, an overdose may lead to dangerously low blood sugar levels, which can result in symptoms such as shakiness, sweating, confusion, blurred vision, and even loss of consciousness.
  • Lactic Acidosis: One of the components of Invokamet, metformin, can result in a rare but severe condition named lactic acidosis, especially if too much is ingested. When lactic acid accumulates in the blood, it can lead to symptoms including muscle pain, weakness, trouble breathing, stomach pain, nausea, and vomiting.
  • Dehydration and Electrolyte Imbalance: Canagliflozin, another component of Invokamet, increases glucose excretion in the urine, leading to dehydration and electrolyte imbalances when taken in excess.
  • Kidney Problems: Overdose might exacerbate any pre-existing kidney issues or potentially trigger new renal complications due to the drug’s effects on kidney function.

[Note: If you have consumed more than the recommended dose of Invokamet, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

How to Store an Invokamet?

  • Store Invokamet at room temperature, typically between 20°C to 25°C. Avoid exposing the medication to extreme temperatures.
  • Keep the medication in its original packaging until use to protect it from moisture and light. Do not store Invokamet in areas like the bathroom where it can be exposed to damp conditions.
  • Ensure that Invokamet is kept in a secure place that is out of the reach of children and pets.
  • Do not freeze Invokamet. Keep it in a cool, dry place where the temperature is stable.
  • Check the expiry date on the Invokamet packaging regularly, and do not use the medication past its expiration date. Expired medicines should be disposed of properly.
  • If you need to dispose of Invokamet, do not throw it in the trash or flush it down the toilet. Contact your pharmacy or your local waste management authorities to learn about take-back programs.

[Note: Discuss with your healthcare expert the proper disposal of unused medication and any questions you may have regarding its storage.]

What Medications Interact with Invokamet?

Invokamet interacts with various medications, which can affect how well Invokamet works or increase your risk of severe side effects. Here are some fundamental medication interactions to be aware of:

  • Diuretics (Water Pills): Loop diuretics, mainly when used with Invokamet, can increase the risk of dehydration and low blood pressure.
  • Insulin and Insulin Secretagogues (such as sulfonylureas): These can elevate the chances of hypoglycemia (low blood sugar). Dose adjustments may be necessary when used with Invokamet.
  • Blood Pressure Medications: Invokamet can enhance the effects of drugs that lower blood pressure, potentially increasing the risk of hypotension (low blood pressure).
  • NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): These can affect kidney function & increase the risk of kidney problems when taken with Invokamet.
  • Rifampin: This antibiotic can decrease the blood levels of canagliflozin, reducing its effectiveness.
  • Digoxin: Invokamet can increase the digoxin levels in your body, necessitating monitoring and possible dose adjustment.
  • Anticonvulsants (such as phenytoin and phenobarbital) can decrease the blood levels of canagliflozin, reducing its effectiveness.
  • HIV Medications (ritonavir, efavirenz): Some HIV medications can affect the levels of canagliflozin, impacting its efficacy and safety.
  • Steroids: These can increase blood sugar levels and potentially decrease the effectiveness of Invokamet.
  • Beta-Blockers: While beta-blockers can mask some of the symptoms of hypoglycemia, they can still be used cautiously.
  • Alcohol: Increases the risk of lactic acidosis when consumed with metformin-containing products like Invokamet.

[Note: This is not a complete list, and there could be other drugs that interact with Invokamet. Make sure to tell your medical professional about any prescription, over-the-counter medicines & herbal products you’re taking.]

What Are the Invokamet Alternatives?

Invokamet combines two active ingredients, canagliflozin (an SGLT2 inhibitor) and metformin, to treat type 2 diabetes. If you’re looking for alternatives to Invokamet, several other medications or combinations can be considered, depending on individual patient needs, tolerability, and the specific recommendation of a healthcare provider. Here are some common alternatives:

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Invokamet Cost & Coupons

The cost of Invokamet can vary widely depending on your prescription drug insurance coverage. If your insurance plan covers prescription medications, it’s important to check whether Invokamet is included and understand your cost responsibilities, which could be a fixed copay or a percentage of the medication’s price. However, not all insurance plans cover Invokamet. Many people seek alternative purchasing options to manage costs. One effective option is to buy Invokamet online from Canada, which often offers more affordable pricing. Purchasing Invokamet from Canadian pharmacies can be cost-effective for those in the USA. At Polar Bear Meds, a trusted Canadian medication provider, you can use the coupon code WELCOMEPB10 to receive a 10% discount on your first purchase of Invokamet.

Frequently Asked Questions

What are the differences between Invokamet and Invokana?

Both Invokamet and Invokana are prescribed for managing type 2 diabetes and may also help reduce the risk of severe heart or kidney complications. The main difference is their composition: Invokana contains only canagliflozin, while Invokamet combines canagliflozin with metformin. This combination in Invokamet can offer additional blood sugar control. Regarding dosage, Invokana is typically taken once daily. In contrast, Invokamet is available in an immediate-release form that is taken twice daily, and an extended-release version (Invokamet XR) is consumed once daily. It’s essential to consult your healthcare provider to determine which medication best fits your needs.

Can Invokamet lead to weight loss?

Yes, in clinical trials, individuals taking Invokamet experienced an average weight reduction of about 4% over 26 weeks. However, it’s important to note that the FDA does not officially sanction Invokamet as a weight loss drug. If weight concerns arise during treatment, discuss them with your healthcare provider to explore suitable weight management strategies. Maintaining a healthy diet and regular exercise remains crucial in managing diabetes effectively.

Is it safe to use Invokamet during pregnancy?

Invokamet is generally not recommended during the second and third trimesters of pregnancy due to potential risks to the unborn baby’s kidneys. If you are pregnant or considering pregnancy, consult your healthcare provider to weigh the risks and benefits of using Invokamet. Your provider can also explore alternative treatment options with you.

Is it safe to consume alcohol while taking Invokamet?

It is advisable to avoid alcohol while on Invokamet. Alcohol can increase the likelihood of hypoglycemia (low blood sugar) in individuals with diabetes, which poses significant health risks. Moreover, combining alcohol with metformin, a component of Invokamet, can heighten the risk of severe side effects such as lactic acidosis. Discuss your alcohol consumption with your healthcare provider to explore strategies for reducing it if necessary.

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