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Invokamet

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

Medically reviewed on May 14, 2018.

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 with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.

Invokamet may also be used for purposes not listed in this medication guide.

Important Information

You should not use Invokamet if you have severe kidney disease or diabetic ketoacidosis (call your doctor for treatment).

Invokamet may cause a serious condition called lactic acidosis. Get emergency medical help if you have: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow 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, or if you have severe kidney disease or 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 this medicine.

Tell your doctor if you have ever had:

  • liver or kidney disease;

  • bladder infections or other urination problems;

  • heart disease, congestive heart failure;

  • blood circulation problems;

  • nerve problems caused by diabetes;

  • a diabetic foot ulcer or amputation;

  • a pancreas disorder or surgery;

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

  • if you are on a low salt diet.

You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk.

Tell your doctor right away if you become pregnant. Canagliflozin may harm the unborn baby if you take this medicine during your second or third trimester.

Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk.

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?

Invokamet is usually taken 2 times per day with meals. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

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

Take with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, and feeling shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

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.

If you need surgery or medical tests, tell any doctor who treats you that you are using Invokamet.

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 keep Invokamet tablets in a daily pill box for longer than 30 days.

Invokamet dosing information

Usual Adult Dose of Invokamet for Diabetes Type 2:

Initial dose: Individualize dose based on patient's current regimen:
-In patients not currently on canagliflozin or metformin: Initial dose: canagliflozin 50 mg-metformin 500 mg orally twice a day
-In patients on metformin: canagliflozin 50 mg plus one-half of the total daily metformin dose orally twice a day
-In patients on canagliflozin: one-half daily dose of canagliflozin plus metformin 500 mg orally twice a day
-In patients already treated with Invokamet: Switch to canagliflozin-metformin at the same total daily dose of each component divided orally twice a day
Adjust dose based on efficacy and tolerability; a gradual dose escalation of metformin will help to reduce gastrointestinal side effects
Maximum dose: canagliflozin 300 mg-metformin 2000 mg per day

Comments: When used in combination with insulin or an insulin secretagogue , a lower dose of insulin or insulin secretagogue may be considered to reduce the risk of hypoglycemia.

Use: An adjunct to diet and exercise to improve glycemic control in adults with Type 2 diabetes mellitus when treatment with both Invokamet is appropriate.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the medicine (with food) as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. You may have severely low blood sugar (extreme weakness, nausea, tremors, sweating, confusion, trouble speaking, fast heartbeats, or seizure).

What should I avoid while taking Invokamet?

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

See also: Invokamet and alcohol (in more detail)

Invokamet side effects

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

Mild symptoms of lactic acidosis may worsen over time, and this condition can be fatal. Get emergency medical help if you have: unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired.

Call your doctor at once if you have:

  • new pain, tenderness, sores, ulcers, or infections in your legs or feet;

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

  • high potassium level - nausea, weakness, tingly feeling, chest pain, irregular heartbeats, muscle weakness;

  • ketoacidosis (too much acid in the blood) - nausea, vomiting, stomach pain, confusion, unusual drowsiness, or trouble breathing;

  • kidney problems - little or no 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.

You may be more likely to have a broken bone while using medicine that contains canagliflozin. Talk with your doctor about ways to keep your bones healthy.

Common Invokamet side effects may include:

  • urinating more than usual;

  • headache, weakness;

  • gas, stomach pain, indigestion;

  • nausea, vomiting; or

  • diarrhea.

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 your other medicines, especially:

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 drug interactions are listed here.

Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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