Invokana vs Afrezza

Listen to the article instead of reading through it.

0:00

Introduction

For patients with type 2 diabetes, certain drugs that alter the levels of glucose in the body can help manage symptoms and stabilize blood sugar levels. Invokana and Afrezza are two such drugs prescribed for this condition. They each impact different aspects of glucose regulation, but both have significant effects on controlling high blood sugar levels in diabetic individuals.

Invokana is a sodium-glucose co-transporter 2 (SGLT2) inhibitor which works by helping the kidneys get rid of glucose from your bloodstream. On the other hand, Afrezza is an ultra-rapid acting insulin that helps to regulate mealtime blood sugar spikes; it acts by lowering levels of glucose when they're high, primarily after meals.

Both medications play different roles in managing diabetes and should be used under medical supervision considering their possible side effects.

What is Invokana?

Canagliflozin (the generic name for Invokana) is a member of the class of drugs known as SGLT2 inhibitors, which was a significant advancement from the prior classes of diabetes medications. Canagliflozin was first approved by the FDA in 2013. Invokana works differently than most other diabetes medicines--it helps kidneys to get rid of glucose from your bloodstream, effectively reducing blood sugar levels for individuals with type 2 diabetes. Its therapeutic effect is largely independent on insulin.

On the contrary, Afrezza (insulin human inhalation powder), an ultra-rapid acting inhaled insulin, represents another treatment option and route of administration compared to injectable insulins for diabetic patients. It's used at mealtime to control high blood sugar in adults with diabetes.

While both are geared towards managing blood glucose levels, their mechanisms differ significantly: while Invokana acts on kidneys inhibiting glucose reabsorption thus promoting its excretion via urine; Afrezza replaces or supplements the natural hormone insulin that controls blood sugar levels directly after meals. Moreover, unlike Invokana which can be taken orally once daily before breakfast; Afrezza must be administered through inhalation at each mealtime making it less convenient but more effective during post-meal spikes in blood sugar level.

What conditions is Invokana approved to treat?

Invokana and Afrezza are both approved for the management of different types of diabetes:

Invokana is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Afrezza, on the other hand, is a rapid-acting inhaled insulin indicated to improve glycemic control in adult patients with diabetes. It can be employed for both type 1 and type 2 diabetes but must be used in combination with long-acting insulin in people with type 1.

How does Invokana help with these illnesses?

Invokana aids in managing diabetes by increasing the amount of glucose excreted through urine. It does this by inhibiting a protein called SGLT2, which is responsible for reabsorbing glucose into the bloodstream from the kidneys. By blocking this process, levels of glucose are maintained lower in the body over longer periods. Glucose is an essential source of energy but can cause serious complications if its level becomes too high in blood.

Afrezza, on the other hand, helps manage diabetes differently; it's an ultra-rapid-acting form of insulin that works to decrease blood sugar levels quickly following meals. Insulin is a hormone that controls how our bodies use and store sugars obtained from food for energy.

People with diabetes have trouble producing or using insulin effectively leading to higher than normal blood sugar levels. By efficiently lowering these raised blood sugar levels post meals, Afrezza can limit the negative effects associated with elevated glucose concentrations and help patients manage their diabetic condition better.

What is Afrezza?

Afrezza is an inhaled insulin product that was first approved by the FDA in 2014. It is a rapid-acting, human insulin analog used to help control high blood sugar levels in adult patients with type 1 and type 2 diabetes. The unique delivery method of Afrezza via inhalation allows it to mimic the natural release pattern of insulin after meals closely, resulting in improved post-meal glucose control compared to traditional injectable insulins like Invokana.

As Afrezza does not involve injections, it has an entirely different administration profile compared to injectable insulins. This mode of administration can be beneficial for patients who have needle phobia or those seeking more convenience and discretion when administering their medication. The side-effect profile also differs from other types of insulins - coughing and throat irritation are common but ordinarily mild and temporary reactions due to its route of administration through the lungs.

What conditions is Afrezza approved to treat?

Afrezza is an FDA-approved medication for the treatment of:

Type 1 diabetes, as a supplementary therapy to long-acting insulin
Type 2 diabetes, in adults who are not adequately controlled on oral medications or basal insulin.

It's important to note that Afrezza is unique because it's an ultra-rapid acting inhaled insulin, providing another method of delivery for patients who might be resistant to traditional injections.

How does Afrezza help with these illnesses?

Insulin, a hormone produced by the pancreas, plays a crucial role in regulating blood glucose levels and allowing cells to use glucose for energy. In conditions such as diabetes where insulin production or usage is impaired, medications like Afrezza can help manage blood sugar levels effectively. Afrezza is an ultra-rapid acting form of inhaled insulin that works by mimicking the natural pattern of insulin release your body would have in response to food intake. It gets absorbed quickly into the bloodstream upon inhalation at the beginning of a meal, thereby controlling post-mealtime spikes in blood sugar level more efficiently than Invokana which is an oral medication used to control high blood sugar by helping kidneys get rid of glucose from your bloodstream. The mode of action on glycemic control may also give Afrezza benefits over Invokana when it comes to flexibility with dosing times and potential weight gain associated with other forms of insulin.

How effective are both Invokana and Afrezza?

Both Invokana (canagliflozin) and Afrezza (insulin human inhalation powder) are FDA-approved treatments for controlling blood glucose levels in patients with type 2 diabetes, but they have different mechanisms of action. Invokana is an oral medication that works by causing the kidneys to get rid of glucose from your bloodstream. On the other hand, Afrezza is a rapid-acting insulin delivered via inhalation.

Invokana's efficacy was evaluated in multiple clinical trials involving more than 10,000 adults with type 2 diabetes. The studies showed that Invokana improved hemoglobin A1c levels and fasting plasma glucose levels when compared to placebo. However, it should be noted that it can lead to side effects such as urinary tract infections and yeast infections due to its mechanism of action.

Afrezza offers an alternative form of insulin administration for those who dislike or have difficulty administering injections. Clinical trials showed Afrezza effectively reduced Hemoglobin A1c over 24 weeks among participants with type 1 or type 2 diabetes mellitus; however, some users experienced coughing immediately after inhaling the drug.

In terms of meta-analyses reviews on these drugs' effectiveness: In a review conducted in 2015, Canagliflozin was found effective at reducing HbA1c levels along with body weight and blood pressure reduction benefits.[3] Meanwhile, a Cochrane database review concluded there was insufficient evidence about long-term effects (>12 months) regarding morbidity or mortality outcomes for people using faster-acting insulins like Afrezza.[4]

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558476/ [4]https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012161.pub2/full

abstract image of a researcher studying a bottle of drug.

At what dose is Invokana typically prescribed?

Dosages of Invokana (Canagliflozin) typically start at 100 mg, taken orally once daily before the first meal of the day. If required and well-tolerated, this dose can be increased to a maximum of 300 mg/day. On the other hand, Afrezza (Inhaled Insulin) dosing is individualized and based on metabolic needs, blood glucose monitoring results and glycemic control goal. It's typically administered at each mealtime in adults with diabetes. The dosage could be changed over time depending on how well it controls your blood sugar levels; however, it should always be under close medical supervision to ensure safety and efficacy.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Afrezza typically prescribed?

Afrezza therapy begins with a dose of 4 units at each meal. Depending on the individual's blood sugar levels, this dose can be increased or decreased under the guidance of a healthcare professional. It is typically used in combination with long-acting insulin for people with type 1 diabetes and may be used alone or combined with oral medication for those living with type 2 diabetes. The maximum daily dosage varies based on the individual’s needs, but it should not exceed what your doctor prescribes as excessive amounts may lead to hypoglycemia (low blood sugar). Regular monitoring of your glucose levels will indicate if there is no response to the initial dose after several days.

What are the most common side effects for Invokana?

Common side effects of Invokana can include:

Thirst
Frequent urination
Nausea and constipation
Genital yeast infections
Urinary tract infections (UTIs)
Changes in urination, including urgent need to go to the bathroom, difficulty in emptying the bladder completely, or blood in the urine
Increased cholesterol levels

On the other hand, Afrezza may cause side effects like:

Cough
Throat pain or irritation
Headache,
Hypoglycemia (low blood sugar)
Diarrhea

It's important for patients using these medications to monitor their symptoms carefully and report any concerns to their healthcare provider.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Invokana?

While Invokana and Afrezza are both used in the management of diabetes, they have different side effects:

For Invokana, serious side effects can include:

Signs of a urinary tract infection such as burning feeling while urinating, frequent or urgent need to urinate, pain in the lower part of your stomach (pelvis), or blood in the urine
Symptoms related to kidney problems like swelling of the face, hands, feet or ankles; shortness of breath; fatigue; nausea; loss of appetite
Dehydration symptoms: dizziness, fainting upon standing up too fast due to low blood pressure
Ketoacidosis signs: nausea and vomiting accompanied by abdominal pain; tiredness and trouble breathing

Afrezza on the other hand may cause severe symptoms including:

Hypoglycemia indicators such as headache, irritability/anxiety/nervousness/confusion/abnormal behavior/mood changes/seizure/unconsciousness
Declining lung function which could present with persistent cough/wheezing/decreased physical ability/shortness of breath during activities you once found easy
Allergic reactions like rash/hives/swelling especially around throat/tongue/lips/eyes that could be coupled with breathing difficulties

If any severe symptoms arise while taking either drug it is crucial you seek immediate medical attention.

What are the most common side effects for Afrezza?

Potential side effects when using Afrezza, a fast-acting inhaled insulin for individuals with diabetes, may include:

Cough and throat irritation
Hypoglycemia or low blood sugar levels, which can cause dizziness, confusion, anxiety or nervousness
Chest pain and palpitations due to rapid heart rate
Shortness of breath
Fatigue or sleep problems
Weight gain rather than weight loss as it is an insulin preparation
Headache
Diarrhea or constipation
Please note these potential side effects would not occur in all users but awareness aids in managing them effectively.

Are there any potential serious side effects for Afrezza?

While Afrezza is generally well tolerated, it can cause certain adverse effects that require immediate medical attention. Symptoms to watch out for include:

Signs of allergic reaction such as hives, itching, rash or difficulty breathing.
Lung problems: trouble breathing, shortness of breath or persistent cough.
Low potassium levels (hypokalemia): symptoms may include muscle pain or weakness, leg cramps and irregular heartbeats.
Sudden changes in vision or blurred vision; this could be indicative of a more serious condition related to diabetes called diabetic retinopathy.
Unusual mood swings which might indicate hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

If you experience any of these symptoms while taking Afrezza, promptly contact your healthcare provider.

Contraindications for Invokana and Afrezza?

Both Invokana and Afrezza, along with most other diabetes medications, may worsen symptoms of hypoglycemia (low blood sugar) in some people. If you notice your blood sugar levels dropping significantly or experiencing symptoms such as dizziness, confusion, irritability or tremors after taking these drugs, please seek immediate medical attention.

Neither Invokana nor Afrezza should be taken if you are using certain medications like rifampin or selegiline which could interact negatively with these drugs. Always inform your healthcare provider about any medication you're currently on; some medicines will require a period to clear from the system before starting treatment with either Invokana or Afrezza. This is done to prevent potentially harmful interactions between different medications that can exacerbate health problems.

How much do Invokana and Afrezza cost?

For the brand name versions of these drugs:

The price for a 30-day supply of Invokana (100 mg) averages around $600, which works out to approximately $20/day.
Alternatively, Afrezza inhalation powder is available in cartridges. A box containing 60 x 4-unit and 60 x 8-unit cartridges costs about $360-$400 making it approximately $12–13/day.

Thus, if you are taking standard doses daily then brand-name Afrezza tends to be less expensive on a per-day treatment basis compared with Invokana.

Please note that cost should not be a primary consideration in determining which of these diabetes medications is right for you. Each has different mechanisms of action and might have differing side effects; furthermore, each patient's individual needs must be considered.

It's also worth noting that there aren't generic versions currently available for either Invokana or Afrezza as they are relatively new drugs protected by patents. When making your choice between them, always consult with your healthcare professional who can provide guidance based on your personal health situation.

Popularity of Invokana and Afrezza

Canagliflozin, also known under the brand name Invokana, was prescribed to approximately 1.7 million people in the US in 2019. This medication is used to control high blood sugar levels in individuals with type-2 diabetes and it accounted for around 8% of SGLT2 inhibitor prescriptions that year.

In contrast, Afrezza (insulin human inhalation powder) is a rapid-acting insulin administered through inhalation at the beginning of each meal. While innovative due to its mode of administration and quick onset action time, Afrezza's use has been limited due to concerns over lung function side effects and drug pricing issues. Accurate prescription data for Afrezza are difficult to find because it represents a small portion of all insulin prescriptions filled annually; however, its usage appears significantly less than Invokana's.

Conclusion

Both Invokana (canagliflozin) and Afrezza (insulin human inhalation powder) are effective treatments for diabetes, with a wealth of clinical studies supporting their efficacy above placebo. Sometimes, these drugs may be used together as part of a broader therapeutic strategy, though this would require careful supervision by a physician due to potential interactions between them. Their mechanisms of action differ significantly; Invokana works by inhibiting the sodium-glucose co-transporter 2 in the kidneys leading to increased glucose excretion, whereas Afrezza is an inhaled insulin that helps control blood sugar levels after meals.

While both drugs have generic alternatives available providing cost savings especially for patients paying out-of-pocket, not all insurance plans cover these versions. Both medications also potentially demand an adaptation period where full benefits may not be immediately apparent.

The side effect profile varies between the two medicines although they are generally well-tolerated. For Invokana common side effects include urinary tract infections and yeast infections while Afrezza can cause coughing or throat irritation upon inhalation. Patients should pay close attention to their blood sugar levels when starting treatment with either drug and seek immediate medical help if they experience symptoms such as extreme thirst or frequent urination - signs that could indicate dangerously high blood sugar levels.