ABOUT THE DRUG
Invokana (canagliflozin) belongs to a new class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors.
…may lead to diabetic ketoacidosis (DKA).Normally, when a person eats, the body produces insulin to process sugar that enters the body. In people with Type 2 diabetes, this response no longer works the way it should, and they develop insulin resistance. Eventually, the pancreas cannot keep up with the demand for insulin and sugar levels rise to dangerous levels. Invokana and other SGLT2 inhibitors work by preventing sugar from being reabsorbed into the blood.
In March 2013, the FDA approved Johnson & Johnson’s Invokana, and it was the first in its class. Then, in 2014, the FDA approved Invokamet (canagliflozin and metformin). However, in May 2015, the agency issued a drug safety communication that warned patients and doctors that these drugs and other SGLT2 inhibitors may lead to diabetic ketoacidosis (DKA).
PURPOSE OF THE DRUG
Invokana works by stopping glucose from being reabsorbed into the blood in the kidneys. It stops a special protein in the kidney called SGLT2 that is responsible for reabsorbing 90 percent of the glucose in the kidneys. Instead of reabsorbing the sugar, the kidneys secrete it, and it leaves the body during urination. This results in lowered levels of glucose in the blood.
In May 2015, the FDA warned that Invokana may lead to a serious condition called diabetic ketoacidosis (DKA). DKA occurs when the body cannot use sugar (glucose) as a fuel source because there is either too little or no insulin.
DKA occurs when the body cannot use sugar (glucose) as a fuel source because there is either too little or no insulin. Instead, the body breaks down fat for energy. Instead, the body breaks down fat for energy. The breakdown of fat produces ketones, which can build up in the body. When these waste products build up in the blood, they become toxic.
Warning symptoms of the condition include nausea, vomiting, difficulty breathing, confusion, abdominal pain and unusual fatigue or sleepiness. The FDA urges patients who are taking SGLT2s and are suffering from these symptoms to seek medical attention immediately.
Thus far, the FDA has reported about 20 cases of ketoacidosis and all of these patients had to go to the hospital for treatment of the condition. Most patients took the drug for about two weeks prior to the appearance of symptoms.
Patients who have taken Invokana have to be vigilant for any signs of DKA, which is considered a medical emergency. Symptoms include confusion, difficulty breathing, unusual fatigue or sleepiness, frequent urination or thirst that lasts for a day or more, flushed face, fruity-smelling breath, aching muscles or muscle stiffness, vomiting and nausea, and stomach pain.
HOW SHIFFMAN & SHIN CAN HELP
Patients need to consult with their physicians to ensure their response to the drug is being closely watched as well as the potential onset of any symptoms of DKA.Invokana has been on the market for a short time, and while it quickly rose to become one of J&J’s top-selling SGLT-2 inhibitors, it has just as quickly fallen from grace given all the recent reports linking it to DKA. The drug remains under close watch and review as the full gamut of possible repercussions, injuries and contraindications has yet to be fully assessed, identified and reported. As such, anyone who has taken Invokana should be mindful of any irregularities in their health, and with the guidance of a medical doctor, consider stopping treatment and seek another suitable drug for their condition.
We are learning more every day about the extent of damage that can be caused by Invokana, says Shiffman Shin. Patients need to consult with their physicians to ensure their response to the drug is being closely watched as well as the potential onset of any symptoms of DKA.