Invokamet

Invokamet is a combination oral medication used to manage type 2 diabetes mellitus in adults. It combines canagliflozin, a SGLT2 inhibitor, with metformin, a biguanide. Together, they help control blood sugar by reducing glucose production in the liver, improving insulin sensitivity, and increasing glucose excretion through urine. Invokamet is typically used when blood sugar is not adequately controlled by metformin alone or other antidiabetic medications.

Benefits

• Provides dual-action glucose control: metformin reduces liver glucose output, and canagliflozin increases urinary glucose excretion.
• Helps reduce HbA1c (glycated hemoglobin) levels effectively.
• Can aid in weight loss, which is often beneficial for patients with type 2 diabetes.
• Associated with lower blood pressure in some patients due to mild diuretic effects.
• Shown to provide cardiovascular and renal protection in high-risk diabetic patients (based on canagliflozin studies).

Dosage

• For metformin-naïve patients: 50 mg canagliflozin / 500 mg metformin twice daily.
• For those already on metformin: switch to equivalent metformin dose with 50 mg or 150 mg canagliflozin.
• Maximum dose: 300 mg canagliflozin / 2000 mg metformin per day, given in divided doses.
• Should be taken with meals to reduce gastrointestinal side effects from metformin.

Warnings and Precautions

• Not for use in type 1 diabetes or diabetic ketoacidosis.
• Risk of lactic acidosis, a rare but serious side effect of metformin; symptoms include muscle pain, breathing difficulty, and unusual tiredness.
• Can increase risk of genital and urinary tract infections due to increased glucose in urine.
• May lead to dehydration or low blood pressure, especially in elderly patients or those on diuretics.
• Risk of ketoacidosis, even if blood sugar is not very high; seek medical help if nausea, vomiting, or abdominal pain occur.
• May increase the risk of lower limb amputations (especially toes), particularly in patients with prior amputation history or peripheral vascular disease.
• Can cause bone fractures and decreased bone mineral density.
• Renal function must be assessed before starting and monitored during treatment. Not recommended if eGFR is below certain thresholds.
• Use with caution in patients with heart failure or those on loop diuretics.
• Not recommended during pregnancy or breastfeeding. Effective contraception should be used.

Usage Instructions

• Take exactly as prescribed by your healthcare provider.
• Always take with food to reduce the risk of stomach upset.
• Swallow tablets whole with a glass of water.
• Take doses at the same time each day for consistent blood sugar control.
• Do not skip doses. If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double up.

Storage Information

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and heat.
• Keep tablets in their original packaging until use.
• Keep out of reach of children and pets.

Common Side Effects

• Mild to moderate effects: Diarrhea, nausea, or stomach discomfort (mostly from metformin), increased urination, genital yeast infections (especially in women), thirst or dry mout) or dizziness or lightheadedness.
• Serious (seek immediate medical attention): Symptoms of lactic acidosis (e.g., muscle pain, difficulty breathing, drowsiness), signs of ketoacidosis (nausea, vomiting, abdominal pain, confusion), amputation warning signs: pain, ulcers, or infection in legs or feet, severe dehydration or fainting or symptoms of kidney problems (swelling, fatigue, decreased urination).