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Invokamet

Generic Name: canagliflozin and metformin (KAN a gli FLOE zin and met FOR min)
Brand Names: Invokamet

What is Invokamet?

Invokamet contains a combination of canagliflozin and metformin. Canagliflozin and metformin are oral diabetes medicines that help control blood sugar levels. Canagliflozin works by helping the kidneys get rid of glucose from your bloodstream. Metformin lowers glucose production in the liver and also causes your intestines to absorb less glucose.

Invokamet is used together with diet and exercise to treat type 2 diabetes.

Invokamet is not for treating type 1 diabetes.

Important information

You should not use Invokamet if you have severe kidney disease, if you are on dialysis, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Invokamet is not for treating type 1 diabetes.

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If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking Invokamet.

Invokamet may cause a serious condition called lactic acidosis. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, fast or uneven heart rate, dizziness, or feeling very weak or tired.

Before taking this medicine

You should not use Invokamet if you are allergic to canagliflozin (Invokana) or metformin (Glucophage, Actoplus Met, Avandamet, Fortamet, Glucovance, Janumet, Jentadueto, Kazano, Kombiglyze, Metaglip, PrandiMet, Riomet), or if you have:

  • kidney disease (or if you are on dialysis); or

  • if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking Invokamet.

Some people taking metformin develop a serious condition called lactic acidosis. This may be more likely if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your risk.

To make sure Invokamet is safe for you, tell your doctor if you have:

  • low blood pressure;

  • liver disease;

  • heart disease, congestive heart failure;

  • a history of stroke or heart attack;

  • an electrolyte imbalance (such as high levels of potassium in your blood);

  • if you are on a low salt diet; or

  • if you are 80 or older and your kidneys have not been tested.

FDA pregnancy category C. It is not known whether Invokamet will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Invokamet.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether canagliflozin and metformin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Invokamet is not approved for use by anyone younger than 18 years old.

How should I take Invokamet?

Your doctor may perform kidney function tests before you start taking Invokamet.

Invokamet is usually taken 2 times per day with meals. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

Your doctor may have you take extra vitamin B12 while you are taking Invokamet. Take only the amount of vitamin B12 that your doctor has prescribed.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine, which can lead to severely low blood pressure or a serious electrolyte imbalance.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, pale skin, irritability, dizziness, feeling shaky, or trouble concentrating. Always keep a source of sugar with you in case you have low blood sugar. Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency.

If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your Invokamet dose or dosing schedule without your doctor's advice.

If you need to fast (stop eating) before a surgery, tell the surgeon ahead of time that you take Invokamet. You may need to stop using the medicine for a short time.

Invokamet can cause positive results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using canagliflozin.

Invokamet is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store tablets in their original container at room temperature, away from moisture and heat. Do not put Invokamet tablets into a daily pill box.

Invokamet dosing information

Usual Adult Dose for Diabetes Type 2:

Initial dose:
-In patients on metformin: Switch to canagliflozin-metformin containing canagliflozin 50 mg with a similar total daily dose of metformin
-In patients on canagliflozin: Switch to canagliflozin-metformin containing metformin 500 mg with a similar total daily dose of canagliflozin
-In patients already treated with Invokamet: Switch to canagliflozin-metformin containing the same total daily doses of each component

Maximum dose:
-Maximum recommended daily dose of metformin (in patients with an eGFR of 60 mL/min/1.73 m2 or greater): 2000 mg
-Maximum recommended daily dose of canagliflozin (in patients with an eGFR of 60 mL/min/1.73 m2 or greater): 300 mg

Comments:
Limitation of use: Drug should not be used in Type 1 diabetes mellitus or diabetic ketoacidosis

Use: An adjunct to diet and exercise to improve glycemic control in adults with Type 2 diabetes mellitus who are not adequately controlled on a regimen containing metformin or canagliflozin, or in patients who are already treated with both canagliflozin and metformin

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of metformin may cause lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid while taking Invokamet?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking Invokamet.

Invokamet side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Invokamet: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Early symptoms of lactic acidosis may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, fast or uneven heart rate, dizziness, or feeling very weak or tired.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • high potassium - slow heart rate, weak pulse, muscle weakness, tingly feeling;

  • signs of a kidney problem - little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath;

  • signs of a bladder infection - pain or burning when you urinate, urine that looks cloudy, pain in pelvis or back; or

  • signs of a genital infection (penis or vagina) - pain, burning, itching, rash, redness, odor, or discharge.

Older adults may be more likely to have kidney problems while taking this medicine.

Common Invokamet side effects may include:

  • urinating more than usual;

  • bladder infection or genital infection;

  • headache, weakness;

  • gas, stomach pain, indigestion;

  • nausea, vomiting, diarrhea; or

  • constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Invokamet?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Invokamet, especially:

  • digoxin (digitalis, Lanoxin);

  • a diuretic or "water pill";

  • insulin or other oral diabetes medications;

  • rifampin;

  • ritonavir; or

  • seizure medicine - phenobarbital, phenytoin.

This list is not complete. Other drugs may interact with canagliflozin and metformin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about Invokamet.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Invokamet only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2015 Cerner Multum, Inc. Version: 1.01. Revision Date: 2014-10-29, 2:10:56 PM.

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