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Generic Name:

canagliflozin-metformin, Oral tablet

Generic Name:

All Brands

  • Invokamet
  • Invokamet XR
SECTION 1 of 4

Highlights for canagliflozin-metformin

Oral tablet
1

Canagliflozin/metformin is used along with diet and exercise to lower blood sugar levels in people with type 2 diabetes.

2

Canagliflozin/metformin is available as the brand-name drugs Invokamet and Invokamet XR. It’s not available as a generic drug.

3

This drug can cause lactic acidosis, a rare but serious side effect due to the buildup of lactic acid in the blood.

4

This drug may cause upset stomach when you start taking it, but this should go away. If your upset stomach comes back again, contact your doctor right away.

5

Canagliflozin increases your risk of yeast or fungal infections on the genitals. If you’ve had genital yeast or fungal infections or if you’re an uncircumcised male, you’re more at-risk for this side effect.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Lactic acidosis. Metformin, one of the drugs in this medication, can cause lactic acidosis. This is a rare side effect due to the buildup of lactic acid in the blood, and it could be fatal. The risk of this side effect is increased if you have certain health problems, such as:

  • kidney failure
  • serious complications from infection
  • dehydration
  • liver failure
  • heart attack
  • stroke
  • congestive heart failure

Your risk is also increased if you drink too much alcohol or have a procedure that uses contrast dye.

Symptoms of lactic acidosis can include:

  • fatigue
  • muscle pain
  • trouble breathing
  • increased sleepiness
  • stomach pain
  • nausea and vomiting

If you have these symptoms while taking canagliflozin/metformin, stop taking it and contact your doctor right away.

Very low blood pressure level (hypotension)

Canagliflozin/metformin can cause hypotension. Tell your doctor if you have or take any drugs for blood pressure. Your doctor will monitor your blood pressure at the beginning and throughout your use of canagliflozin/metformin.

Very low blood sugar levels (hypoglycemia)

Canagliflozin/metformin can cause hypoglycemia when used in combination with drugs called secretagogues (glyburide, glipizide) or insulin. Symptoms include sweating, nervousness, shakiness, weakness, hunger, nausea, dizziness, headache, and blurred vision. Your doctor may decide to lower the dose of your secretagogue to minimize the risk of hypoglycemia.

Ketoacidosis

This drug may cause diabetic ketoacidosis. This is a life-threatening complication of diabetes. It happens when your body makes high levels of the blood acids called ketones. If you develop ketoacidosis, your doctor may have you stop taking this drug temporarily or permanently.

What is canagliflozin/metformin?

Canagliflozin/metformin is a prescription drug. It’s available as an oral tablet.

Canagliflozin/metformin is a combination of two drugs in a single form. It is important to know about all the drugs in the combination because they each may have unique traits.

Canagliflozin/metformin is not available as a generic medication. It’s available as the brand-name drugs Invokamet and Invokamet XR. Invokamet is an immediate-release drug. Invokamet XR is an extended-release drug.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

Canagliflozin/metformin is used along with diet and exercise to decrease blood sugar levels in people with type 2 diabetes.

How it works

Canagliflozin belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Metformin belongs to a class of drugs called biguanides.

More Details

How It Works

Canagliflozin belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Metformin belongs to a class of drugs called biguanides. A class of drugs refers to medications that work similarly. They’re often used to treat similar conditions.

Canagliflozin/metformin is a tablet that combines two drugs with different actions to decrease blood sugar levels. For example, canagliflozin works by removing sugar from your blood and helping your body dispose of it in your urine. Metformin reduces blood sugar levels in your blood after meals by:

  • decreasing the amount of sugar your intestines absorb
  • decreasing the amount of sugar your liver makes
  • increasing the use of sugar in your blood
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SECTION 2 of 4

canagliflozin-metformin Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with canagliflozin/metformin include:

  • vaginal yeast infection. Symptoms may include:

    • vaginal odor
    • white or yellowish vaginal discharge
    • vaginal itching
  • yeast infection of the penis. Symptoms may include:

    • swelling
    • redness
    • itching
    • foul-smelling discharge from the penis
    • pain in the skin around the penis
    • rash on the penis
  • urinary tract infection. Symptoms may include:

    • feeling a very strong urge to urinate
    • urinating more often but in small amounts
    • itching, burning, or pain when you urinate
    • urine that smells strong
    • urine that looks cloudy or has an unusual color
  • changes in urination, including urgent need to urinate more often, in larger amounts, or at night

  • diarrhea

  • nausea

  • vomiting

  • gas

  • weakness

  • indigestion

  • upset stomach

  • headache

Tell your doctor if you have any side effect that bothers you or that doesn’t go away. These aren’t all the possible side effects of canagliflozin/metformin. For more information, ask your doctor or pharmacist.

If these effects are mild, they may disappear within a few days or a couple of weeks. If they’re more severe or don’t disappear, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • allergic reactions. Symptoms may include:

    • skin rash
    • itching or hives
    • swelling of the face, lips, or tongue
    • trouble breathing
  • lactic acidosis. Symptoms may include:

    • severe weakness or tiredness
    • unusual (not normal) muscle pain
    • trouble breathing
    • unusual sleepiness or sleeping longer than usual
    • stomach pains, nausea, or vomiting
    • dizziness or lightheadedness
    • slow or irregular heartbeat
  • low vitamin B12 levels

  • dehydration. Symptoms may include:

    • dizziness
    • fainting
    • lightheadedness
    • weakness, especially when you stand up
  • kidney damage. Symptoms may include:

    • tiredness
    • weakness
    • shortness of breath
  • increased potassium levels. Symptoms may include:

    • abnormal heart beat
  • diabetic ketoacidosis. Symptoms may include:

    • excessive thirst
    • urinating more often than normal
    • nausea
    • vomiting
    • stomach pain
    • weakness
    • shortness of breath
    • fruity smelling breath
    • confusion
  • very low blood sugar levels (hypoglycemia). Symptoms may include:

    • sweating
    • nervousness
    • irritability
    • shakiness
    • weakness
    • hunger
    • nausea
    • dizziness
    • headache
  • broken bones

Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Canagliflozin/metformin doesn’t cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

canagliflozin-metformin May Interact with Other Medications

Oral tablet

Canagliflozin/metformin can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interaction

Avoid drinking alcohol very often, or drinking a lot of alcohol in a short period of time ("binge" drinking). It can increase your chances of getting serious side effects, including lactic acidosis.

Medications That Might Interact with This Drug

Heart drugs
  • amiloride
  • digoxin
  • procainamide
  • quinidine
  • triamterene

These drugs are removed from your body through your kidneys. Taking them with metformin could lead to a buildup of metformin in your body. This could lead to lactic acidosis.

Taking canagliflozin/metformin and digoxin together can increase the amount of digoxin in your body. Your doctor will monitor your drug levels more closely, and may change the dose of one of the drugs.

Drugs for infection
  • quinine
  • trimethoprim
  • vancomycin

These drugs are removed from your body through your kidneys. Taking them with metformin could lead to a buildup of metformin in your body. This could lead to lactic acidosis.

Heartburn drugs
  • ranitidine
  • cimetidine

These drugs are removed from your body through your kidneys. Taking them with metformin could lead to a buildup of metformin in your body. This could lead to lactic acidosis.

Pain medication
  • morphine

This drug is removed from your body through your kidneys. Taking it with metformin could lead to a buildup of metformin in your body. This could lead to lactic acidosis.

Seizure drugs
  • topiramate
  • zonisamide
  • phenytoin
  • phenobarbital

Topiramate and zonisamide decrease the levels of a chemical called bicarbonate in your blood. Low levels of bicarbonate increase your risk of lactic acidosis. Phenytoin and phenobarbital may increase your blood sugar levels.

Glaucoma drugs
  • acetazolamide
  • dichlorphenamide

These drugs decrease the levels of a chemical called bicarbonate in your blood. Low levels of bicarbonate can increase your risk of lactic acidosis, a rare side effect of metformin.

Thiazides and other diuretics

These drugs can increase your blood sugar level. Your doctor may need to change your dose of canagliflozin/metformin when it’s taken with these drugs.

Blood pressure medicines

These drugs include potassium-sparing diuretics and others, such as:

  • amiloride
  • triamterene
  • spironolactone
  • enalapril
  • benazepril
  • captopril

These drugs can interfere with the removal of potassium from your body and increase your risk of hyperkalemia. These drugs can also cause low blood pressure. Your doctor may recommend another diabetes drug if this occurs.

Blood pressure drugs also include calcium channel blockers, thiazides, and other diuretics, such as:

  • hydrochlorothiazide
  • amiloride
  • chlorthalidone
  • metolazone
  • furosemide
  • triamterene

These drugs can increase your blood sugar level. Your doctor may need to change your dosage of canagliflozin/metformin if you take it with these drugs. These drugs can also cause low blood pressure. Your doctor may recommend a different diabetes drug if this occurs.

Drugs for inflammation
  • prednisone
  • prednisolone
  • methylprednisolone

Thyroid products
  • levothyroxine
  • Armour thyroid
  • Thyrolar

These drugs can increase your blood sugar level. Your doctor may need to change your dose of canagliflozin/metformin when it’s taken with these drugs.

Drugs for psychiatric disorders
  • chlorpromazine
  • thioridazine
  • perphenazine
  • fluphenazine
  • prochlorperazine
  • trifluoperazine

These drugs can increase your blood sugar level. Your doctor may need to change your dosage of canagliflozin/metformin if you take it with any of these drugs.

Birth control pills
  • ethinyl estradiol
  • levonorgesterol
  • estrogen
  • estradiol
  • norethindrone

These drugs can increase your blood sugar level. Your doctor may need to change your dose of canagliflozin/metformin when it’s taken with these drugs.

Tuberculosis drugs
  • isoniazid
  • rifampin

Isoniazid can increase your blood sugar level. Your doctor may need to change your dose of canagliflozin/metformin when it’s taken with this drug.

Rifampin decreases canagliflozin levels in your blood. Your doctor may give you a higher dose of canagliflozin/metformin if you take these drugs together.

Drug for cholesterol
  • niacin

This drug can increase your blood sugar level. Your doctor may need to change your dose of canagliflozin/metformin when it’s taken with this drug.

HIV drug
  • ritonavir

This drug can decrease canagliflozin levels in your blood. If you need to take it with canagliflozin/metformin, your doctor may give you a higher dosage of canagliflozin/metformin or switch you to a different diabetes drug.

Other diabetes drugs
  • insulin
  • glyburide
  • glipizide

These drugs also can lower your blood sugar. Taking canagliflozin/metformin with these drugs can cause very low blood sugar levels (hypoglycemia). Your dose of these drugs may have to be changed when you’re taking canagliflozin/metformin.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Canagliflozin/metformin Warnings
liver damange
People with liver damage

This drug is processed in your liver. If you have liver damage and take this drug, metformin is more likely to build up in your body. This puts you at higher risk of lactic acidosis, a condition that could lead to heart failure and could be fatal.

hypotension
People with hypotension

If you have low blood pressure, your doctor may recommend a different drug to treat your diabetes.

kidney damage
People with kidney damage

Canagliflozin/metformin decreases kidney function. Metformin is mainly removed by the kidneys. The risk of metformin buildup and lactic acidosis increases if you have kidney damage and take this drug. If you have moderate or severe kidney disease, don’t take this drug.

yeast infection
People who have had fungal or yeast infections

Canagliflozin increases the risk of genital yeast or fungal infections. If you have a history of genital yeast or fungal infections, or you’re an uncircumcised male, you’re more likely to develop genital yeast or fungal infections while taking this drug.

vitamin B deficiency
People with vitamin B-12 deficiency

Metformin may lower vitamin B-12 levels. This may be due to decreased absorption of vitamin B-12 while you take metformin. Your doctor will monitor your vitamin B-12 levels and they may suggest you take a vitamin supplement.

high cholesterol
People with high cholesterol

Taking this drug can increase your levels of bad cholesterol. If you already have high levels of bad cholesterol, your doctor may make changes to your cholesterol medications.

pregnant women
Pregnant women

Use of canagliflozin/metformin is not recommended during the second or third trimester of pregnancy. This is because of the possible risk to your infant of serious kidney problems.

If you’re pregnant, talk with your doctor about the best way to control your blood sugar. Tell your doctor right away if you become pregnant during treatment with canagliflozin/metformin.

breastfeeding
Women who are nursing

Use of canagliflozin/metformin is not recommended while you are breastfeeding. This is because of the possible risk to your infant of serious kidney problems.

for seniors
For Seniors

As you get older, your kidney function slows. Your doctor will monitor your kidney function more closely to make sure you can safely take canagliflozin/metformin.

for children
For Children

The safety and effectiveness of canagliflozin/metformin haven’t been established in people younger than 18 years old.

Special Kid Safety:

Keep this drug out of the reach of children.

allergies
Allergies

Symptoms of an allergic reaction to canagliflozin/metformin can include:

  • rash
  • raised red patches on your skin (hives)
  • swelling of the face, lips, tongue, and throat that may cause difficulty breathing or swallowing

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

SECTION 4 of 4

How to Take canagliflozin-metformin (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Type 2 diabetes

Brand: Invokamet

Form: immediate-release oral tablet
Strengths: 50 mg canagliflozin/500 mg metformin, 50 mg canagliflozin/1,000 mg metformin, 150 mg canagliflozin/500 mg metformin, and 150 mg canagliflozin/1,000 mg metformin

Brand: Invokamet XR

Form: extended-release oral tablet
Strengths: 50 mg canagliflozin/500 mg metformin, 50 mg canagliflozin/1,000 mg metformin, 150 mg canagliflozin/500 mg metformin, and 150 mg canagliflozin/1,000 mg metformin
Adult Dosage (ages 18-64 years)

Invokamet

Your doctor will start you on canagliflozin/metformin based on your dosage of these drugs individually:

  • If you’re not currently being treated with either canagliflozin or metformin, you should start therapy with one tablet of 50 mg canagliflozin/500 mg metformin.
  • If you’re taking canagliflozin only, your dose of canagliflozin/metformin will contain 500 mg of metformin, with an amount of canagliflozin similar to your current dose.
  • If you’re already being treated with canagliflozin and metformin separately, you’ll take the dosage of canagliflozin/metformin that contains the same total daily doses you currently receive of each drug individually.
  • The maximum recommended daily dose of canagliflozin is 300 mg.
  • Take your doses of canagliflozin/metformin twice daily with meals.

Invokamet XR

Your doctor will start you on extended-release canagliflozin/metformin based on your dosage of these drugs individually:

  • If you’re currently not being treated with either canagliflozin or metformin, you should start therapy with two tablets, each containing 50 mg canagliflozin and 500 mg metformin.
  • If you’re taking metformin only, you will switch to two tablets equal to a starting dose of 100 mg canagliflozin daily, with an amount of metformin similar to your current dose.
  • If you’re taking canagliflozin only, you will switch to two tablets equal to a starting dose of 1,000 mg metformin daily, with an amount of canagliflozin similar to your current dose.
  • If you’re already being treated with canagliflozin and metformin separately, you’ll switch to taking two tablets containing the same or similar total daily dosage that you currently receive of each drug individually.
  • The maximum recommended daily dose of canagliflozin is 300 mg.
  • Take your extended-release canagliflozin/metformin once daily with your morning meal.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years old hasn’t been established.

Senior Dosage (ages 65 years and older)
  • Your body processes this drug more slowly. Your doctor will monitor your kidney function more closely to make sure you can safely take canagliflozin/metformin.
  • The maximum recommended daily dose of metformin is 2,000 mg.
Special considerations

People with moderate kidney problems: The canagliflozin component of your medication should not be more than 50 mg in each tablet.

People with severe kidney problems: You should not take canagliflozin/metformin.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Canagliflozin/metformin comes with serious risks if you don't take it as prescribed.

If You Don’t Take It at All

If you don’t take it at all, your blood sugar will remain at a level that is too high and possibly lead to kidney damage, nerve damage, and eye damage.

If You Skip or Miss Doses

If you don’t take it as scheduled or miss doses, this drug won’t be as effective and might stop controlling your blood sugar level.

If You Take Too Much

If you take too much of this drug, you may be at a higher risk for lactic acidosis. Lactic acidosis is rare but can sometimes cause death. You may also have low blood sugar, which can be dangerous.

What to Do If You Miss a Dose

If you forget to take your dose, take it as soon as you remember, unless you remember just a few hours before the time for your next dose. Then only take one dose. 

Never try to catch up by taking two tablets at once. This could result in toxic side effects. Talk to your doctor if you have questions about a missed dose.

How to Tell If the Drug Is Working

You’ll notice a decrease in your blood sugar.

Canagliflozin/metformin is a long-term drug treatment.

Important Considerations for Taking Canagliflozin/metformin
take with food
Canagliflozin/metformin should be taken as prescribed with food
can crush or cut
Can I cut or crush?
See Details
storage
Store this drug at 68–77°F (20–25°C)
See Details
refillable
Prescription is refillable
travel
Travel
See Details
clinical monitoring
Clinical Monitoring
See Details
sun sensitivity
Sun Sensitivity
See Details
not usually stocked
Not every pharmacy stocks this drug, so call ahead
prior authorization
Insurance
See Details

Store this drug at 68–77°F (20–25°C)

This drug can be stored temporarily in temperatures from 59–86°F (15–30°C).

Store it in the original container and keep it away from light and high temperature.

Keep canagliflozin/metformin out of the reach of children.

Keep your drugs away from areas where they could get wet, such as bathrooms. Store these drugs away from moisture and damp locations.

Can I cut or crush?

Invokamet: You can cut or crush the tablet.

Invokamet XR: Do not cut, crush, or chew this tablet. Always swallow it whole. It may appear in your feces as a soft mass that may look like the original tablet. This is normal.

Travel

When traveling with your medication:

  • Always carry your medication with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines; they can’t hurt your medication.
  • You may need to produce your pharmacy’s preprinted label clearly identifying the medication. Keep the original pharmacy prescription labeled box when traveling with your medication.
  • Don’t put this medicine in your glove compartment or leave it in the car, especially when the temperature is hot or freezing.

Clinical Monitoring

Your doctor will check your blood sugar level. Your doctor may also check your kidney function.

Your doctor will check your hemoglobin A1c level to see how well your blood sugar levels have been controlled over the past 3 months.

Sun Sensitivity

Photosensitivity or sun sensitivity-related adverse reactions occurred in people taking canagliflozin in clinical studies. Avoid exposure to sunlight and protect your skin using sunscreen or protective clothing.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for this drug.

Are There Any Alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by University of Illinois-Chicago, Drug Information Group on May 3, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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