Invokamet (Canagliflozin, Metformin Hydrochloride)

Invokamet consists of the drugs canagliflozin and metformin. It is an oral antidiabetic medication. It has a few indications, including that it:

Improves glycemic control in adults with type 2 diabetes mellitus (T2DM) in addition to diet and exercise
Decreases the risk of serious cardiovascular events (e.g. death, myocardial infarction, stroke) in adults with T2DM and cardiovascular disease (CVD)
Decreases the risk of developing end-stage kidney disease (ESKD), serum creatinine doubling, death from cardiovascular causes, and hospitalization for heart failure in adults with T2DM and diabetic nephropathy with albuminuria over 300 mg/day
Controlling hyperglycemia prevents downstream complications such as kidney damage, loss of limbs, blindness, heart attack, stroke, or nerve problems. Cardiovascular and renal events in diabetes can also be detrimental. It is important that diabetes and related events remain controlled to lessen the chance of related complications. Invokamet is not indicated for the treatment of type 1 diabetes.

HOW DOES INVOKAMET WORK?
Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. SGLT2 is a transporter that reabsorbs filtered glucose in the proximal renal tubules. Invokamet inhibits SGLT2, decreasing renal reabsorption of glucose and lessening the renal glucose threshold, which elevates the amount of glucose excreted into the urine. By preventing SGLT2-dependent reabsorption of glucose and sodium, Invokamet also increases the amount of sodium getting to the distal tubule. This elevates tubuloglomerular feedback and decreases intraglomerular pressure. Metformin is a biguanide that lowers the production of hepatic glucose, lowers absorption of glucose in the intestine, and improves insulin sensitivity through increasing peripheral glucose. Insulin release does not change with metformin, however, fasting levels of insulin and day-long plasma insulin response can be lowered.

SIDE EFFECTS
Common side effects include:

Yeast infection
Urination changes (e.g. increased urgency, increased frequency)
Urinary tract infection
Low blood sugar
Hypersensitivity reactions
Increased hemoglobin
Limb injury
Increased thirst
Abdominal pain
Constipation
Diarrhea
Flatulence
Nausea and vomiting