Is it safe to take Invokana?
Medically reviewed by Sally Chao, MD. Last updated on Sep 15, 2020.
Invokana is a medication that lowers blood sugar levels in adults with type 2 diabetes. It's generally safe for most people to take, but it can have some serious side effects. An increased risk of lower limb amputations in people who have or are at risk for cardiovascular disease (CVD) is the most significant side effect associated with taking Invokana.
Lower limb amputation
Invokana was associated with a two-fold higher risk of lower limb amputation of the toe or midfoot (and more rarely the leg) in people with CVD or at risk for CVD.
Your doctor will evaluate your personal risk of a lower limb amputation and watch you closely. People who may have a higher risk include those with:
- A past amputation
- Nerve problems (diabetic neuropathy)
- Sores or ulcers on the feet
- Peripheral vascular disease
Invokana is in a class of drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors. A serious, though rare, complication associated with taking an SGLT2 inhibitor is a potentially life-threatening genital infection called necrotizing fasciitis of the perineum (Fournier’s gangrene).
Other possible side effects
People using Invokana may also be more prone to:
- Bone fractures
- Diabetic ketoacidosis
- Kidney problems
- Low blood sugar levels (hypoglycemia) when used with insulin
However, the most common side effects of Invokana are:
- Genital yeast infections
- Urinary tract infections
- Increased urination
Although these problems occurred more often in people taking the drug than a placebo, type 2 diabetes can also lead to similar complications if blood sugar levels aren't well-controlled, so it's important to talk to your doctor about the risks and benefits of any medication you're considering.
Your doctor should monitor you for any sores, ulcers, new pain or other signs of possible infection when starting Invokana. Let your doctor know if you notice any new symptoms.
Who should not take Invokana
Invokana is approved for use by adults with type 2 diabetes, so adults with type 1 diabetes should not take it. It is also not known if the drug is safe and effective in pediatric patients younger than 18 years old, so Invokana should only be taken by adults.
- U.S. Food and Drug Administration (FDA). Invokana. July 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/204042s026lbl.pdf. [Accessed August 7, 2020].
- U.S. Food and Drug Administration (FDA). FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes. August 29, 2018. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes. [Accessed August 11, 2020].
- American Diabetes Association. Complications. Available at: https://www.diabetes.org/diabetes/complications. [Accessed August 11, 2020].
- Jakher H, Chang TI, Tan M, Mahaffey KW. Canagliflozin review - safety and efficacy profile in patients with T2DM. Diabetes Metab Syndr Obes. 2019;12:209-215. doi: 10.2147/DMSO.S184437.
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