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Invokana vs Metformin
Introduction
For patients with Type 2 Diabetes, certain drugs that regulate the level of glucose in the blood can help manage symptoms and prevent complications. Invokana and Metformin are two such drugs commonly prescribed for this condition. They each work on different mechanisms but both have a significant effect on lowering blood sugar levels in diabetic patients. Metformin is classified as a biguanide, it reduces hepatic glucose production and improves insulin sensitivity thereby decreasing the amount of circulating glucose. Invokana, on the other hand, is known as a sodium-glucose co-transporter 2 (SGLT2) inhibitor; it primarily works by preventing the reabsorption of glucose by kidneys leading to excretion of excess sugar via urine.
Invokana vs Metformin Side By Side
| Attribute | Invokana | Metformin |
|---|---|---|
| Brand Name | Invokana | Metformin |
| Contraindications | Severe renal impairment, use of certain diuretics (water pills) which could increase the risk for orthostatic hypotension. | Significant kidney disease, use of certain diuretics (water pills) without appropriate medical supervision. |
| Cost | For the brand name, around $500 for 30 tablets (100 mg). Generic version ranges from $15 to $50 per day depending on dosage. | For the brand name, about $25 for 60 tablets (500 mg). Generic version costs as low as about $0.10 to no more than around $0.50 daily based on common dosages. |
| Generic Name | Canagliflozin | Metformin |
| Most Serious Side Effect | Ketoacidosis, severe dehydration symptoms, serious liver problems, signs of an allergic reaction. | Lactic Acidosis, signs of allergic reactions, breathing problems, unusually tiredness. |
| Severe Drug Interactions | Certain diuretics, drugs that may increase the risk of dehydration or blood pressure changes. | Alcohol, iodinated contrast agents, other diabetes medications that may lower blood sugar. |
| Typical Dose | Starts at 100 mg once daily, can be increased to 300 mg/day if necessary and well-tolerated. | Initiated at 500 mg once or twice a day, can be increased gradually to a total of 2000-2550 mg per day given in divided doses. |
What is Invokana?
Canagliflozin (the generic name for Invokana) is a drug from the SGLT2 inhibitor class of antidiabetic medications, which marked an important advance over the first generation of diabetes drugs called biguanides, such as Metformin. Canagliflozin was first approved by the FDA in 2013. Invokana works by blocking a protein called SGLT2 that reabsorbs glucose back into your bloodstream while your kidneys are filtering it out, thereby allowing more glucose to be excreted in urine and reducing blood sugar levels. It is prescribed mainly for treating type 2 diabetes. Invokana has a selective influence on SGLT2 proteins with only minor effects on other renal transporters, which results in it having fewer side effects than older diabetic drugs that have stronger impacts on various metabolic pathways.
What conditions is Invokana approved to treat?
Invokana (Canagliflozin) is approved for the treatment of certain conditions related to type 2 diabetes:
- As an adjunct to diet and exercise, it improves glycemic control in adults with type 2 diabetes mellitus
- To reduce the risk of major cardiovascular events such as heart attack or stroke in patients with type 2 diabetes mellitus and established cardiovascular disease
- For reducing the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in patients with type 2 diabetes mellitus and diabetic nephropathy with albuminuria.
How does Invokana help with these illnesses?
Invokana, also known as canagliflozin, helps to manage type 2 diabetes by reducing the amount of glucose reabsorbed in the kidneys. It does this by inhibiting a protein called sodium-glucose co-transporter 2 (SGLT2), which is responsible for most of the glucose reabsorption in the kidneys. By blocking SGLT2, Invokana causes excess glucose to be excreted from the body through urine thereby lowering blood sugar levels. Glucose plays an important role in providing energy for cells, maintaining normal function of nerves and muscles, and several other metabolic processes.
On the other hand, Metformin works differently; it reduces hepatic glucose production and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. This means that while both drugs are used to control high blood sugar levels in people with Type 2 diabetes they work on different parts of your body's natural insulin management systems. So choosing between them often depends on patient-specific factors such as kidney function or personal comfort regarding medication side effects.
What is Metformin?
Metformin is a first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. It was first approved by the FDA in 1994 and it works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. Metformin does not increase insulin levels and so has less risk of causing low blood sugar (hypoglycemia) compared to other antidiabetic drugs. Unlike Invokana, which is a SGLT2 inhibitor that causes excess glucose to be eliminated through urine, metformin primarily reduces glucose absorption from food and increases muscle's uptake of glucose while also reducing hunger due to its effect on leptin levels. While both Invokana and Metformin can lead to weight loss, Metformin does not typically lead to dehydration or urinary tract infections which are potential side effects with Invokana use. The benefits on blood sugar control with metformin can help mitigate complications associated with diabetes such as eye disease (retinopathy), kidney disease (nephropathy), nerve damage (neuropathy), heart disease, stroke amongst others.
What conditions is Metformin approved to treat?
Metformin has been approved by the FDA for managing and treating:
- Type 2 diabetes mellitus
- Prediabetes, in order to prevent progression to overt diabetes In addition, it's also frequently used off-label for polycystic ovary syndrome (PCOS), a hormonal disorder common among women of reproductive age.
How does Metformin help with these illnesses?
Metformin is a first-line medication for the treatment of type 2 diabetes, particularly in overweight and obese people and those with normal kidney function. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues, thus effectively lowering blood sugar levels. Metformin has been shown to be beneficial in many ways beyond simply controlling diabetes; it may also contribute to heart health, longevity, weight loss, and more. Unlike Invokana which acts on the kidneys causing elimination of excess glucose through urine, metformin's mechanism focuses primarily on reducing hepatic glucose production as well as increasing insulin sensitivity at cellular level. In cases where patients do not respond adequately or are intolerant to other oral antidiabetic drugs (such as Invokana), metformin can play a crucial role in managing their condition due to its different mode of action.
How effective are both Invokana and Metformin?
Both canagliflozin (Invokana) and metformin have established histories of success in treating patients with type 2 diabetes. They were initially approved by the FDA a couple of decades apart, but both are considered first-line treatments for this condition. Metformin has been around longer and is generally the first drug given to newly diagnosed type 2 diabetics, while Invokana is newer and may be prescribed when metformin alone isn't enough or isn't tolerated.
A double-blind clinical trial directly compared canagliflozin against metformin in 2013; these two drugs exhibited similar efficacy in managing blood sugar levels as well as renal function improvement. In this study, none of the different metrics studied to measure efficacy in controlling glucose differed significantly between patients receiving invokana and those receiving metformin.
A review from various meta-analysis reports on metformin suggested that it is effective right from the initial period of treatment, that its side effect profile is favorable over many other antidiabetic medications, and that it's well-tolerated even among elderly populations. This review also reported that Metformin has become one of the most widely-prescribed antidiabetic drugs globally due to its effectiveness at reducing blood sugar levels without causing weight gain - a common side effect with many other diabetes medicines.
As per a recent review and meta-analysis, Invokana seems more effective than placebo at decreasing HbA1c levels (a long-term marker for blood sugar control) along with additional benefits like weight reduction & BP lowering potential which was not noticed much with Metformin use extensively. Nonetheless, because Invokana acts differently than traditional anti-diabetes medications by working on kidneys to remove excess glucose through urine – presenting some unique advantages like less hypoglycemia risk & additive effects over existing therapies.
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At what dose is Invokana typically prescribed?
Oral dosages of Invokana typically start at 100 mg once daily, taken before the first meal of the day. If necessary and well-tolerated, this can be increased to 300 mg/day. However, for Metformin, initial dosage usually starts from 500mg twice a day or 850 mg once a day with meals in adults. Depending on the patient's response to treatment and tolerability after a few weeks, it could be increased up to a maximum dosage of 2550mg per day divided into three doses. As always, these medications should only be adjusted under the guidance of your healthcare provider.
At what dose is Metformin typically prescribed?
Metformin therapy is generally initiated at a dosage of 500 mg once or twice a day. The dose can be gradually increased by 500 mg weekly or 850 mg every two weeks, as tolerated, to a total of 2000-2550 mg per day given in divided doses. Doses above 2000 mg may be better tolerated when given in three divided doses with meals. If there's no sufficient response to the maximum dose after several weeks, additional measures like lifestyle modification or adding another antidiabetic drug may be considered. As with all medications, it is important that Metformin is taken exactly as prescribed and monitored by your healthcare provider.
What are the most common side effects for Invokana?
Common side effects of Invokana can include:
- Frequent urination
- Thirstiness due to increased hydration requirements
- Yeast infections in both men and women
- Nausea
- Constipation or diarrhea
- Fatigue, generalized weakness and dizziness
- Skin sensitivity to sunlight resulting in rash or itching
On the other hand, Metformin's common side effects may encompass:
- Stomach upset leading to nausea, vomiting, bloating, gas and diarrhea
- Unusual metallic taste in the mouth (dysgeusia)
- Decreased appetite (anorexia)
- Weakness (asthenia) accompanied by fatigue General malaise.
Remember that these are general observations; individual reactions can vary greatly. Always consult with a healthcare provider for personalized advice regarding medication.
Are there any potential serious side effects for Invokana?
In rare instances, Invokana and Metformin can cause potentially serious side effects. These could include:
- Signs of an allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.
- Severe dehydration symptoms: feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin
- Symptoms related to a urinary tract infection: burning sensation when you urinate; frequent or urgent need to urinate; pain in lower part of your stomach area (pelvis); fever; blood in your urine
- Ketoacidosis (too much acid in the blood) which may include symptoms like nausea/vomiting; unusual tiredness; shortness of breath
- Serious liver problems like nausea/vomiting that doesn't stop, loss of appetite/stomach pain on upper right side/jaundice(yellowing skin/eyes)/dark urine
- Lactic Acidosis - unusual muscle pain/cramping/difficulty breathing/belly pain with vomiting/unexplained weight loss
If any such conditions arise while taking either Invokana or Metformin immediately consult with your healthcare provider for further instructions.
What are the most common side effects for Metformin?
Metformin, a common medication for type 2 diabetes, can come with its own set of side effects. These may include:
- Upset stomach or nausea
- Vomiting and diarrhea
- Loss of appetite leading to weight loss
- A metallic taste in the mouth
- Headache, weakness or lack of energy
- Symptoms resembling the flu such as chills and muscle pain In rare cases there might be instances of:
- Rash or itching It's important to note that metformin can also cause lactic acidosis – a serious metabolic complication - although this is rare. If you experience slow heart rate, cold feeling, shortness of breath along with stomach discomfort while on Metformin seek immediate medical assistance.
Are there any potential serious side effects for Metformin?
While Metformin is generally safe and effective, some users may experience serious side effects. These include:
- Signs of allergic reactions such as skin rash, itching or hives; swelling of the face, lips or tongue
- Breathing problems
- Feeling faint or lightheaded, falls
- Low blood sugar (hypoglycemia) can happen more often when metformin is taken with other diabetes medications. Early signs include: sweating; shakiness; fast heartbeat; hunger; blurred vision.
- Muscle aches or pains that are not from exercise
- Stomach upset accompanied by nausea and vomiting
- Unusually tiredness
If you notice any of these symptoms after taking Metformin, it's important to seek immediate medical attention. Always remember to take medication under the supervision of a healthcare professional who knows your medical history and current health status.
Contraindications for Invokana and Metformin?
Both Invokana and Metformin, like many other diabetes medications, may worsen symptoms of low blood sugar levels in some people. If you notice your blood sugar dropping too low or if you experience symptoms such as shakiness, sweating, confusion, irritability or dizziness seek immediate medical attention.
Neither Invokana nor Metformin can be taken if you are using certain types of diuretics (water pills) which could increase the risk for a sudden drop in blood pressure when standing up (orthostatic hypotension). Always disclose to your physician any medications that you might be taking; certain drugs will require an appropriate interval to clear from the system to prevent potentially harmful interactions with both Metformin and Invokana.
Additionally, it is important to note that significant kidney disease contraindicates the use of metformin while severe renal impairment prohibits the usage of invokana. It's also crucial to monitor for signs and symptoms of urinary tract infections or yeast infections -- common side effects associated with Invokana.
How much do Invokana and Metformin cost?
For the brand name versions of these drugs:
- The cost for 30 tablets of Invokana (100 mg) averages around $500, which works out to approximately $16-$17/day depending on your dose.
- The price for 60 tablets of Metformin (500 mg) is about $25, working out to roughly $0.40/day.
Thus, if you are in the higher dosage range for Invokana (i.e., 300 mg/day or higher), then brand-name Metformin is significantly less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions:
- Canagliflozin (generic version of Invokana) comes with an approximate cost range from $15 to $50 per day depending upon the dosage.
- Generic Metformin has considerably lower costs, ranging from as low as about$0.10 to no more than around $0.50 daily based on common dosages.
Popularity of Invokana and Metformin
Canagliflozin, commonly known by the brand name Invokana, is a relatively newer medication used to treat type 2 diabetes. In 2020, it was estimated that about 1.3 million people in the US were prescribed this medicine. Canagliflozin accounts for just over 7% of SGLT-2 inhibitor prescriptions in the US and has been gradually increasing in prevalence since its approval by the FDA in March 2013.
On the other hand, Metformin remains one of the most widely prescribed drugs for type 2 diabetes with around 81 million prescriptions filled annually in America alone. This represents approximately over half of all antidiabetic drug prescriptions. The prevalence of metformin use has remained steady throughout recent years largely due to its proven safety profile, efficacy and cost-effectiveness.
Conclusion
Both Invokana (canagliflozin) and Metformin have solid records of usage in patients with type 2 diabetes, supported by numerous clinical trials highlighting their efficacy over placebo treatments. In some scenarios, these drugs may be administered together for a more comprehensive management of blood glucose levels. However, the combination requires careful medical supervision due to potential drug interactions.
Invokana and Metformin operate through different mechanisms: Invokana works primarily by inhibiting SGLT2 proteins in the kidneys to prevent reabsorption of glucose, while Metformin reduces hepatic glucose production and improves insulin sensitivity.
Metformin is typically considered as the first-line treatment option for type 2 diabetes due to its long history of use, effectiveness, safety profile and cost-effectiveness. Invokana might be chosen as an add-on therapy when metformin alone doesn't sufficiently control blood sugars or when metformin is not tolerated.
Both drugs are available generically which can result in significant savings for uninsured patients or those paying out-of-pocket. They may require an adaptation period; therefore effects might not be immediately noticeable.
The side effect profiles are relatively similar between both medications; they're generally well-tolerated but come with their own sets of risks. For instance, invokana has been linked with increased risk of lower limb amputations and urinary tract infections whereas metformin commonly causes gastrointestinal upset such as diarrhea or nausea particularly at initiation or dose increases. As always when starting new medications individuals should closely monitor their health status especially if any adverse symptoms develop they should consult healthcare professionals promptly.
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Refrences
- Rosenthal, N., Meininger, G., Ways, K., Polidori, D., Desai, M., Qiu, R., … Demarest, K. (2015, August 25). Canagliflozin: a sodium glucose co‐transporter 2 inhibitor for the treatment of type 2 diabetes mellitus. Annals of the New York Academy of Sciences. Wiley.http://doi.org/10.1111/nyas.12852
- Krentz, A. J., & Bailey, C. J. (2005). Oral Antidiabetic Agents. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200565030-00005
- Nathan, N., & Sullivan, S. (2014, March 30). The Utility of Metformin Therapy in Reproductive-Aged Women with Polycystic Ovary Syndrome (PCOS). Current Pharmaceutical Biotechnology. Bentham Science Publishers Ltd.http://doi.org/10.2174/1389201015666140330195142
- Cullen, E., Liao, J., Lukacsko, P., Niecestro, R., & Friedhoff, L. (2004, June 7). Pharmacokinetics and dose proportionality of extended‐release metformin following administration of 1000, 1500, 2000 and 2500 mg in healthy volunteers. Biopharmaceutics & Drug Disposition. Wiley.http://doi.org/10.1002/bdd.407
- Ashraf, S., Upreti, P., Karki, S., Khan, M., & Nasr, R. (2022, April 17). Metformin-Associated Lactic Acidosis: A Case Report and Review. Cureus. Springer Science and Business Media LLC.http://doi.org/10.7759/cureus.24220
- Carbone, S., & Dixon, D. L. (2019, May 28). The CANVAS Program: implications of canagliflozin on reducing cardiovascular risk in patients with type 2 diabetes mellitus. Cardiovascular Diabetology. Springer Science and Business Media LLC.http://doi.org/10.1186/s12933-019-0869-2
- Joseph, C. M. C. (2021, April 28). Symptomatic Hypoglycemia During Treatment with a Therapeutic Dose of Metformin. American Journal of Case Reports. International Scientific Information, Inc.http://doi.org/10.12659/ajcr.931311
- Postula, M., Rosiak, M., Kosior, D., & Grzeszczak, S. (2014, August). Emerging treatments in type 2 diabetes: focus on canagliflozin. Therapeutics and Clinical Risk Management. Informa UK Limited.http://doi.org/10.2147/tcrm.s39145