Invokana (Canagliflozin)
SGLT2 Inhibitor for Type 2 Diabetes and Kidney Protection
Quick Facts About Invokana
Key Takeaways About Invokana
- Dual benefit in diabetes: Invokana lowers blood sugar through an insulin-independent mechanism and also provides kidney and cardiovascular protection in type 2 diabetes patients
- Once-daily oral tablet: Take one tablet daily, preferably before the first meal of the day, with or without food
- Amputation risk warning: Clinical studies have shown an increased risk of lower limb amputations (particularly toes and midfoot) – monitor your feet regularly and report any sores or pain
- Watch for diabetic ketoacidosis: A rare but serious side effect that can occur regardless of blood sugar levels – seek emergency care if you experience nausea, vomiting, abdominal pain, or fruity-smelling breath
- Not for type 1 diabetes: Invokana is indicated only for type 2 diabetes and should never be used to treat type 1 diabetes or diabetic ketoacidosis
What Is Invokana and What Is It Used For?
Invokana (canagliflozin) is an SGLT2 inhibitor that treats type 2 diabetes by blocking sugar reabsorption in the kidneys, causing excess glucose to be removed from the body through urine. It also helps prevent cardiovascular disease and slows the progression of diabetic kidney disease.
Invokana contains the active substance canagliflozin, which belongs to a class of medicines known as sodium-glucose co-transporter 2 (SGLT2) inhibitors. These medications represent a relatively modern approach to managing type 2 diabetes, working through a mechanism that is entirely independent of insulin secretion or sensitivity. By targeting the kidneys rather than the pancreas, SGLT2 inhibitors offer a unique and complementary pathway for blood sugar control.
In the healthy kidney, approximately 180 grams of glucose is filtered through the glomeruli each day. Under normal circumstances, virtually all of this glucose is reabsorbed back into the bloodstream by SGLT2 transporters located in the proximal convoluted tubule. Canagliflozin selectively blocks these transporters, reducing renal glucose reabsorption by approximately 30–50%. This results in the excretion of roughly 70–120 grams of glucose per day in the urine, effectively lowering blood sugar levels while also providing a modest caloric deficit.
Invokana is approved for the treatment of adults and children aged 10 years and older with type 2 diabetes. It can be used as monotherapy when diet and exercise alone do not provide adequate glycaemic control, or in combination with other antidiabetic medications including metformin, insulin, DPP-4 inhibitors (such as sitagliptin, saxagliptin, or linagliptin), sulfonylureas (such as glimepiride or glipizide), and pioglitazone.
Beyond its glucose-lowering effects, landmark clinical trials such as the CANVAS Program and the CREDENCE trial have demonstrated that canagliflozin provides significant cardiovascular and renal benefits. The CREDENCE trial, published in the New England Journal of Medicine in 2019, showed that canagliflozin reduced the risk of kidney failure, cardiovascular death, and hospitalisation for heart failure in patients with type 2 diabetes and chronic kidney disease. These findings have positioned SGLT2 inhibitors as a cornerstone of modern diabetes management, particularly for patients with established cardiovascular or renal complications.
What Is Type 2 Diabetes?
Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance and relative insulin deficiency. In this condition, the body either does not produce enough insulin or the cells do not respond effectively to the insulin that is produced. As a result, glucose accumulates in the bloodstream instead of being taken up by cells for energy. Over time, persistently elevated blood sugar levels can lead to serious complications affecting the heart, kidneys, eyes, nerves, and blood vessels. According to the World Health Organization (WHO), approximately 422 million people worldwide have diabetes, with type 2 diabetes accounting for around 90–95% of all cases.
What Should You Know Before Taking Invokana?
Before starting Invokana, your doctor needs to assess your kidney function, cardiovascular history, and current medications. Invokana is contraindicated in patients with type 1 diabetes, diabetic ketoacidosis, or those on dialysis, and requires careful monitoring throughout treatment.
Contraindications
You should not take Invokana if you are allergic to canagliflozin or any of the other ingredients in the tablet. The inactive ingredients include lactose, microcrystalline cellulose, hydroxypropyl cellulose, croscarmellose sodium, and magnesium stearate. The film coating contains polyvinyl alcohol, titanium dioxide, macrogol/PEG 3350, and talc. The 100 mg tablet also contains yellow iron oxide.
Invokana must not be used in patients with type 1 diabetes, as the drug was not developed for this condition and carries an elevated risk of diabetic ketoacidosis in this population. Similarly, it should not be used to treat diabetic ketoacidosis itself. Patients with severe renal impairment (estimated glomerular filtration rate below 30 mL/min/1.73 m2 for glucose-lowering purposes) or those on dialysis should not take Invokana for glycaemic control, although your doctor may consider its renal protective effects in some clinical contexts.
Warnings and Precautions
Before and during treatment with Invokana, speak with your healthcare provider about the following important safety considerations:
A rare but potentially life-threatening complication. Seek immediate medical attention if you experience rapid weight loss, nausea or vomiting, abdominal pain, excessive thirst, rapid and deep breathing, confusion, unusual drowsiness, a sweet or metallic taste in your mouth, or a fruity odour to your breath or urine. DKA can occur even when blood sugar levels appear normal. The risk increases during prolonged fasting, excessive alcohol consumption, dehydration, sudden reduction in insulin dose, or during major surgery or serious illness.
Clinical studies (CANVAS Program) have shown that canagliflozin may increase the risk of amputation of the lower extremities, particularly of toes and the midfoot. Regularly inspect your feet and follow all advice on foot care and adequate fluid intake. Notify your doctor immediately if you discover wounds, discolouration, or tenderness in your feet. Patients with a history of prior amputation, peripheral vascular disease, or neuropathy may be at higher risk.
A rare but extremely serious soft tissue infection of the genital area that requires immediate surgical intervention. Seek emergency care if you develop pain, tenderness, redness, or swelling of the genitals or the area between the genitals and the anus, accompanied by fever or general malaise.
Additional precautions include the risk of dehydration and low blood pressure (hypotension), particularly in elderly patients over 75 years, patients with kidney problems, and those taking diuretics. Tell your doctor if you have a history of cardiovascular disease, stroke, liver problems, or recurrent urinary tract or genital infections. If you are scheduled for major surgery requiring prolonged fasting, your doctor may advise you to temporarily stop Invokana.
Because of how Invokana works, your urine will test positive for glucose while you are taking the medication. This is expected and not a cause for concern.
Your kidneys will be assessed with a blood test before you start Invokana and at regular intervals during treatment. This helps your doctor determine if the dose needs to be adjusted and ensures the medication remains safe and effective for you.
Pregnancy and Breastfeeding
Invokana should not be used during pregnancy. Animal studies have demonstrated adverse effects on fetal kidney development. If you become pregnant while taking Invokana, stop the medication immediately and consult your doctor for alternative blood sugar management strategies. Women of childbearing potential should use effective contraception during treatment.
Invokana should not be taken during breastfeeding. It is not known whether canagliflozin passes into human breast milk. Discuss with your doctor whether to discontinue the medication or to stop breastfeeding, taking into account the benefit of therapy for the mother and the potential risks for the infant.
Driving and Operating Machinery
Invokana has no or negligible direct effect on the ability to drive or use machines. However, dizziness has been reported, which may impair your ability to drive safely. When canagliflozin is taken together with insulin or a sulfonylurea, the risk of hypoglycaemia increases. Signs of low blood sugar include blurred vision, tingling in the lips, trembling, sweating, pallor, mood changes, anxiety, or confusion. If you experience these symptoms, do not drive or operate machinery until you have treated the low blood sugar and feel well again.
Important Information About Ingredients
Invokana contains lactose. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking this medicine. Invokana contains less than 1 mmol sodium (23 mg) per tablet, meaning it is essentially sodium-free.
How Does Invokana Interact with Other Drugs?
Invokana can interact with several medications including insulin, sulfonylureas, diuretics, and enzyme-inducing drugs like rifampicin. These interactions can affect blood sugar levels, blood pressure, or the effectiveness of either medication.
Always inform your doctor or pharmacist about all medications you are currently taking, have recently taken, or might take. Drug interactions with canagliflozin can alter the effectiveness of treatment or increase the risk of side effects. Your healthcare provider may need to adjust dosages or monitor you more closely when certain medications are combined.
Major Interactions
| Drug / Class | Interaction Effect | Clinical Action |
|---|---|---|
| Insulin | Increased risk of hypoglycaemia when used together | Doctor may reduce insulin dose to prevent low blood sugar |
| Sulfonylureas (glimepiride, glipizide) | Increased risk of hypoglycaemia when used together | Doctor may reduce sulfonylurea dose |
| Diuretics (furosemide, hydrochlorothiazide) | Increased risk of dehydration and low blood pressure due to additive fluid loss | Monitor blood pressure and hydration; dose adjustments may be needed |
| Rifampicin | Reduces canagliflozin levels by inducing UGT enzymes, decreasing effectiveness | Consider increasing canagliflozin to 300 mg if on 100 mg; monitor blood sugar |
| Phenytoin, Phenobarbital, Carbamazepine | May reduce canagliflozin levels through enzyme induction | Monitor blood sugar closely; dose increase may be necessary |
Other Notable Interactions
| Drug / Class | Interaction Effect | Clinical Action |
|---|---|---|
| Digoxin / Digitoxin | Canagliflozin may increase digoxin blood levels | Monitor digoxin levels when starting or changing canagliflozin dose |
| Dabigatran | Canagliflozin may increase dabigatran exposure | Monitor for signs of bleeding; dose adjustments may be needed |
| Lithium | Diuretic effect of canagliflozin may alter lithium levels | Monitor lithium levels during initiation and dose changes |
| Efavirenz / Ritonavir | May alter canagliflozin metabolism (induction/inhibition) | Monitor blood sugar; inform your HIV specialist |
| Cholestyramine | May reduce absorption of canagliflozin if taken at the same time | Take canagliflozin at least 1 hour before or 4–6 hours after cholestyramine |
| St John’s Wort | Herbal enzyme inducer that may reduce canagliflozin blood levels | Avoid concomitant use; discuss alternatives with your doctor |
Because canagliflozin is primarily metabolised by UGT1A9 and UGT2B4 glucuronidation rather than by cytochrome P450 enzymes, it has relatively fewer drug interactions than many other medications. However, potent UGT enzyme inducers (such as rifampicin) can significantly reduce canagliflozin exposure, potentially reducing its glucose-lowering efficacy. Conversely, the mild P-glycoprotein inhibitory properties of canagliflozin can modestly increase levels of digoxin and dabigatran.
The blood pressure-lowering effects of Invokana (through osmotic diuresis and natriuresis) are additive with antihypertensive medications and diuretics. While this can be clinically beneficial for many patients, it may also cause symptomatic hypotension, particularly during treatment initiation in patients already on aggressive blood pressure management. Signs of excessive fluid loss include dizziness, lightheadedness, fainting, dry mouth, extreme thirst, weakness, and reduced urine output.
What Is the Correct Dosage of Invokana?
The usual starting dose of Invokana is 100 mg once daily, taken before the first meal of the day. Your doctor may increase the dose to 300 mg daily based on your response and kidney function. The dose may be limited to 100 mg in patients with reduced kidney function.
Always take Invokana exactly as your doctor or pharmacist has instructed. Do not change the dose or stop taking the medication without consulting your healthcare provider first. The optimal dose depends on your individual clinical situation, including kidney function, other medications you are taking, and your glycaemic response.
Adults
Standard Adult Dosage
Starting dose: 100 mg once daily, taken orally before the first meal of the day.
Dose escalation: Your doctor may increase the dose to 300 mg once daily if additional glycaemic control is needed and the 100 mg dose is well tolerated.
Renal impairment: The dose may be limited to 100 mg daily if you have moderate kidney problems. Your doctor will assess your kidney function to determine the appropriate dose.
Children (Aged 10 Years and Older)
Paediatric Dosage
Dose: Invokana may be prescribed for children with type 2 diabetes aged 10 years and older at a dose determined by the treating physician. No data are available for children under 10 years of age, and Invokana is not recommended for this age group.
Elderly Patients
Dosage in Elderly Patients
No specific dose adjustment is required based on age alone. However, elderly patients, particularly those aged 75 years and older, may be more susceptible to side effects related to dehydration and volume depletion. More careful monitoring of kidney function and hydration status is recommended. Your doctor may start with the lowest available dose and adjust based on tolerability.
How to Take Invokana
Swallow the tablet whole with water. You can take it with or without food, although it is best to take it before the first meal of the day. Try to take the tablet at the same time each day to help you remember. If your doctor has prescribed canagliflozin together with a bile acid sequestrant such as cholestyramine, take canagliflozin at least 1 hour before or 4 to 6 hours after the bile acid sequestrant to avoid reduced absorption.
It is important to continue following your doctor’s advice on diet and exercise while taking Invokana. This is particularly important if you are following a diabetes-specific diet to control your weight – continue following it while taking this medication. Your doctor may also prescribe Invokana alongside other blood glucose-lowering agents; remember to take all your medications as directed.
Missed Dose
If you forget to take a dose, take it as soon as you remember. However, if it is nearly time for your next dose, skip the missed dose and take the next one at the usual time. Do not take a double dose (two doses on the same day) to make up for a forgotten dose.
Overdose
If you have taken more Invokana than prescribed, contact your doctor or go to the nearest hospital emergency department immediately. An overdose may cause excessive glucose excretion, dehydration, and electrolyte imbalances. Bring your medication packaging with you so that healthcare professionals can identify what you have taken.
Your blood sugar levels may rise if you stop taking Invokana. Never discontinue this medication without first discussing it with your healthcare provider, as they may need to adjust your overall diabetes treatment plan to maintain adequate blood sugar control.
What Are the Side Effects of Invokana?
Like all medicines, Invokana can cause side effects, although not everyone gets them. The most common side effects include genital yeast infections, urinary tract infections, and increased urination. Serious but rare side effects include diabetic ketoacidosis, lower limb amputations, and Fournier’s gangrene.
The side effect profile of SGLT2 inhibitors is directly related to their mechanism of action. By increasing glucose in the urine, canagliflozin creates an environment that favours the growth of yeast organisms in the genital area, making genital mycotic infections the most commonly reported adverse effect. The osmotic diuretic effect also leads to increased urination and, in susceptible individuals, dehydration and related complications.
Severe allergic reaction (rare): swelling of the face, lips, mouth, tongue, or throat that may cause difficulty breathing or swallowing.
Diabetic ketoacidosis (rare): elevated ketone levels in urine or blood, rapid weight loss, nausea or vomiting, abdominal pain, excessive thirst, rapid and deep breathing, confusion, unusual sleepiness, sweet-smelling breath or a metallic taste in the mouth. This can occur regardless of your blood sugar level.
Very Common
May affect more than 1 in 10 people
- Vaginal yeast infection (vulvovaginal candidiasis)
- Low blood sugar (hypoglycaemia) when used with insulin or a sulfonylurea
Common
May affect up to 1 in 10 people
- Genital yeast infection in men (balanitis or balanoposthitis)
- Urinary tract infections
- Changes in urination (increased frequency, larger volumes, urinary urgency, nocturia)
- Constipation
- Thirst
- Nausea
- Changes in blood lipids (cholesterol levels)
- Increased haematocrit (red blood cell count)
Uncommon
May affect up to 1 in 100 people
- Dehydration (more common in elderly patients, those with kidney problems, or those taking diuretics)
- Skin rash, hives, or blistering rashes
- Changes in kidney function (elevated creatinine or urea)
- Elevated potassium levels
- Elevated blood phosphate levels
- Bone fractures
- Kidney failure (mainly as a consequence of severe dehydration)
- Lower limb amputations (particularly toes), especially in patients at high cardiovascular risk
- Phimosis (difficulty retracting the foreskin)
- Photosensitivity reactions (skin reactions after sun exposure)
Rare
May affect up to 1 in 1,000 people
- Severe allergic reaction (anaphylaxis)
- Diabetic ketoacidosis
Not Known
Frequency cannot be estimated from available data
- Fournier’s gangrene (necrotising fasciitis of the perineum) – a serious soft tissue infection of the genital or perianal region
Contact your doctor promptly if you experience signs of a urinary tract infection (fever, chills, burning during urination, back or side pain) or if you notice blood in your urine. If you develop signs of a genital yeast infection (irritation, itching, unusual discharge, or odour), treatment is usually straightforward with standard antifungal therapy, but you should inform your doctor.
The risk of hypoglycaemia when using Invokana alone is very low because the mechanism of action depends on glucose filtration through the kidneys. However, when combined with insulin or sulfonylureas, the risk of low blood sugar increases significantly. Symptoms of hypoglycaemia include blurred vision, tingling lips, trembling, sweating, pallor, mood changes, anxiety, or confusion. Your doctor will advise you on how to recognise and manage these episodes.
If you experience any side effects, including those not listed above, tell your doctor, pharmacist, or nurse. You can also report side effects directly to your national pharmacovigilance authority (such as the FDA MedWatch program in the US, the MHRA Yellow Card Scheme in the UK, or the EMA EudraVigilance system in the EU). Reporting helps monitor the ongoing benefit-risk balance of medicines.
How Should You Store Invokana?
Store Invokana at room temperature, out of reach of children. No special storage conditions are required. Do not use the medication after the expiry date on the packaging.
Keep this medicine out of sight and reach of children. Do not use Invokana after the expiry date (marked as “EXP”) on the blister pack and carton. The expiry date refers to the last day of that month.
No special storage conditions are required for Invokana. Store it at room temperature in its original packaging to protect it from moisture and light. Do not use the tablets if the packaging is damaged or shows signs of tampering.
Do not dispose of medications via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help protect the environment and prevent accidental exposure.
What Does Invokana Contain?
The active ingredient in Invokana is canagliflozin (as hemihydrate). The tablets are available in 100 mg (yellow) and 300 mg (white) strengths, both as film-coated immediate-release tablets.
Each Invokana tablet contains canagliflozin hemihydrate equivalent to either 100 mg or 300 mg of canagliflozin. The inactive ingredients (excipients) in the tablet core include lactose, microcrystalline cellulose (E460[i]), hydroxypropyl cellulose (E463), croscarmellose sodium (E468), and magnesium stearate (E572).
The film coating consists of polyvinyl alcohol (E1203), titanium dioxide (E171), macrogol/PEG 3350 (E1521), and talc (E553b). The 100 mg tablet additionally contains yellow iron oxide (E172).
Appearance and Pack Sizes
Invokana 100 mg: Yellow, capsule-shaped, immediate-release film-coated tablets, 11 mm long, with “CFZ” on one side and “100” on the other.
Invokana 300 mg: White, capsule-shaped, immediate-release film-coated tablets, 17 mm long, with “CFZ” on one side and “300” on the other.
Invokana is supplied in PVC/aluminium perforated unit-dose blisters. Pack sizes include cartons of 10×1, 30×1, 90×1, or 100×1 tablets. Not all pack sizes may be marketed in all countries.
The marketing authorisation holder is Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. Additional information is available from the European Medicines Agency (EMA) website.
Frequently Asked Questions About Invokana
Invokana (canagliflozin) is an SGLT2 inhibitor used to treat type 2 diabetes in adults and children aged 10 years and older. It lowers blood sugar by increasing the amount of glucose removed from the body through urine. Invokana also provides cardiovascular protection and helps slow the progression of diabetic kidney disease. It can be used alone or in combination with other diabetes medications such as metformin, insulin, or sulfonylureas.
The most serious risks include diabetic ketoacidosis (a rare but potentially life-threatening condition involving elevated ketone levels), lower limb amputations (particularly of the toes and midfoot, as observed in the CANVAS clinical trial), and Fournier’s gangrene (a very rare but severe genital infection). Dehydration and acute kidney injury are also possible, particularly in elderly patients or those taking diuretics. Regular monitoring by your healthcare provider helps detect and manage these risks early.
Yes, many patients experience modest weight loss while taking Invokana. By causing excess glucose to be excreted in the urine (approximately 70–120 grams per day), the medication creates a caloric deficit of about 280–480 calories daily. In clinical trials, patients lost an average of 2–4 kg over 26 weeks compared to placebo. However, Invokana is not approved as a weight loss medication, and its primary purpose is to control blood sugar in type 2 diabetes.
Invokana and metformin work through completely different mechanisms. Metformin primarily reduces glucose production by the liver and improves insulin sensitivity, while Invokana works in the kidneys by blocking glucose reabsorption so that excess sugar is excreted in the urine. These complementary mechanisms make them excellent combination partners. Unlike metformin, Invokana has demonstrated specific renal and cardiovascular protective benefits in clinical trials. However, metformin remains the first-line treatment for type 2 diabetes in most guidelines.
Invokana increases the amount of glucose in the urine, which creates a more favourable environment for bacteria and yeast to grow. This is why urinary tract infections and genital yeast infections are among the most common side effects. To reduce this risk, maintain good personal hygiene, stay well hydrated, and urinate regularly. Women may be at higher risk of vaginal candidiasis, while men may experience balanitis. Notify your doctor if you develop symptoms of infection, as prompt treatment is usually effective.
No, Invokana should not be used during pregnancy. Animal studies have shown adverse effects on fetal kidney development. If you become pregnant while taking Invokana, you should stop the medication immediately and consult your doctor for alternative diabetes management. Women of childbearing potential should discuss effective contraceptive methods with their healthcare provider. Invokana is also not recommended during breastfeeding.
References and Sources
- Neal B, Perkovic V, Mahaffey KW, et al. “Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes.” New England Journal of Medicine. 2017;377(7):644–657. doi:10.1056/NEJMoa1611925 (CANVAS Program)
- Perkovic V, Jardine MJ, Neal B, et al. “Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy.” New England Journal of Medicine. 2019;380(24):2295–2306. doi:10.1056/NEJMoa1811744 (CREDENCE Trial)
- European Medicines Agency (EMA). “Invokana (canagliflozin) – Summary of Product Characteristics.” Last updated 2025.
- American Diabetes Association. “Standards of Care in Diabetes – 2024.” Diabetes Care. 2024;47(Supplement_1):S1–S321.
- Davies MJ, Aroda VR, Collins BS, et al. “Management of Hyperglycaemia in Type 2 Diabetes, 2022. A Consensus Report by the ADA and EASD.” Diabetologia. 2022;65(12):1925–1966.
- KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International. 2022;102(5S):S1–S127.
- World Health Organization (WHO). “Global Report on Diabetes.” Geneva: WHO; 2024.
- U.S. Food and Drug Administration (FDA). “Invokana (canagliflozin) – Prescribing Information.” Revised 2024.
- British National Formulary (BNF). “Canagliflozin.” National Institute for Health and Care Excellence (NICE). 2025.
- McGuire DK, Shih WJ, Cosentino F, et al. “Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes: A Meta-analysis.” JAMA Cardiology. 2021;6(2):148–158.
Editorial Team
Medical Content
Written by the iMedic Medical Editorial Team, specialists in endocrinology, diabetology, and clinical pharmacology. All content follows the GRADE evidence framework and international guidelines from ADA, EASD, and WHO.
Medical Review
Reviewed by the iMedic Medical Review Board, an independent panel of board-certified physicians who verify all medical claims against current peer-reviewed evidence and clinical guidelines.
Last medical review: | Evidence level: 1A (systematic reviews and RCTs) | Conflict of interest: None declared | Funding: No commercial funding