Invokana (Canagliflozin) – Focus Blocks

Invokana (Canagliflozin) was the first in a new class of diabetes drugs, which work by altering normal kidney functions so that sugar is excreted through the urine.

It was approved in March 2013 by the FDA, and has rapidly grown to become a blockbuster medication.

The class of drugs, known as Sodium-Glucose Costransporter-2 (SGLT2) inhibitors, also includes the new medications Farxiga, Glyxambi, Jardiance, and Xigduo XR. They are approved as a second-line drug to treat type 2 diabetes.

Since Invokana was introduced, it has been linked to hundreds of adverse event reports of kidney failure, kidney damage and diabetic ketoacidosis, as well as urinary tract infections, hypersensitivity and weight loss.

Manufacturer: Johnson & Johnson

Mechanism of Action: These drugs inhibit a form of proteins, which help to reabsorb glucose into the blood, called sodium-glucose transport proteins (SGLT2). By blocking these proteins, less glucose is reabsorbed into the blood and the excess glucose is passed out in urine.

Indications: Canagliflozin are TGA approved as an adjunct to diet and exercise for glycaemic control in adults with type 2 diabetes mellitus

Limitation of use: Not recommended in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis


History of serious hypersensitivity reaction to Invokana

Severe renal impairment, ESRD or on dialysis

Serious Side Effects:   The organization said the FDA has received over 457 adverse events for Invokana in its first 12 months on the market, mostly falling into six categories:

  • Kidney failure or impairment
  • Kidney stones
  • Fluid/electrolyte problems
  • Urinary tract infections
  • Weight-loss
  • Hypersensitivity
  • The most serious potential side effects, problems and risks caused through the use Invokana (Invokamet) are myocardial infarction (heart attack), kidney damage and ketoacidosis.
  • Kidney failure occurs when your kidneys stop functioning without the use of dialysis or a kidney transplant
  • Myocardial infarction (commonly known as a heart attack) is the irreversible death of cells within the heart caused by restriction of blood.
  • Ketoacidosis (Diabetic ketoacidosis, Ketosis) is a very serious, potentially fatal condition where the acid level in the blood rises dangerously high

Symptoms of ketoacidosis include:

  • Difficulty breathing
  • Nausea
  • Vomiting
  • Abdominal pain
  • Confusion
  • Unusual fatigue or sleepiness

Common side effects of Invokana may include:

  • Genital yeast infections (in both male and female)
  • Urinary tract infection
  • Sun intolerance
  • Rash or itching
  • Fatigue
  • Nausea
  • Laboratory abnormalities including cholesterol changes


  1. Whether the patient was prescribed Invokana?
  2. Reason for Prescription? 
  3.  Dosage and Intake details (To be included under pharmacy log)
  4. Did the patient have any pre-existing conditions, allergies or contraindications for Invokana?
  5. What was the injury due to Invokana (Ketoacidosis/Kidney failure/MI)?
  6. When and where was the injury diagnosed? Whether hospitalized? Dates of hospitalization?
  7. Treatment/management. Any complications
  8. Follow-up visits for treatment/management of injury.
  9. Outcome/prognosis. Resolution of injury?

Specific Focus

Identify and report cases with the following scenarios:

No Injuries: Patient took Invokana but did not develop any injuries

No Invokana intake: Patient was given a different drug and not Invokana – Hold case and communicate to client

Invokana contraindicated in patient but still prescribed

Any medical/surgical history, social history that could have had an effect on the injury

Submit Case

If you have a case to be reviewed and summarized, please reach out to us at 610-674-6901 or email us at [email protected]

Published On: February 23, 2021 / Categories: Dangerous Drugs /