Invokamet (Canagliflozin/Metformin) – Drug Information, Side Effects, Dosing, and Savings for Americans Buying from Canada

Invokamet is a prescription medication that combines two well-known type 2 diabetes treatments into one tablet: canagliflozin (an SGLT2 inhibitor) and metformin (a biguanide). It is used to improve blood sugar control along with diet and exercise in adults with type 2 diabetes.

What Invokamet Is Used For

Invokamet is indicated to improve glycemic control as an adjunct to diet and exercise in adults with type 2 diabetes who are not adequately controlled on metformin alone or metformin combined with other diabetes medicines (such as a sulfonylurea, pioglitazone, or insulin). It may also be used when a patient is already taking canagliflozin and metformin as separate tablets and wants a single combination product.

Invokamet is not intended for type 1 diabetes and is not used to treat diabetic ketoacidosis.

How Invokamet Works

• Canagliflozin (SGLT2 inhibitor): helps lower blood sugar by causing the kidneys to remove glucose through the urine. This can also lead to mild fluid loss (osmotic diuresis).
• Metformin: lowers glucose production by the liver and improves insulin sensitivity, helping the body use insulin more effectively.

Because Invokamet contains metformin, taking it with meals is important for tolerability. Because it contains an SGLT2 inhibitor, hydration, genital/urinary symptom awareness, and sick-day planning are also important.

Dosage Forms and Strengths

Invokamet is an immediate-release oral tablet. Strengths may include:

• 50 mg/500 mg
• 50 mg/1000 mg
• 150 mg/500 mg
• 150 mg/1000 mg

How to Take Invokamet

• Invokamet is taken by mouth twice daily with meals to help reduce stomach side effects from metformin.
• Swallow tablets whole.
• Try to take it at consistent times each day (for example, breakfast and dinner).

Missed dose

• If you miss a dose, take it as soon as you remember unless it’s almost time for the next dose.
• If it’s close to your next dose, skip the missed dose and resume your normal schedule.
• Do not double up doses.

Dosing Basics and Dose Adjustment (High-Level)

Your prescriber will choose the tablet strength based on your current metformin dose, your kidney function, and how well your blood sugars are controlled.

• Dose increases are usually gradual to reduce metformin-related stomach upset.
• Kidney function (eGFR) must be checked before starting and monitored over time.
• In people taking insulin or a sulfonylurea, the prescriber may reduce those doses to lower the risk of hypoglycemia when Invokamet is added.

There are specific kidney-based limits and situations where Invokamet should not be used (see contraindications below).

Who Should Not Take Invokamet (Contraindications)

Invokamet is not for everyone. It should not be used in patients with:

• Allergy to canagliflozin, metformin, or any ingredient in the product
• Severe kidney impairment (including very low eGFR), end-stage renal disease, or dialysis
• Acute or chronic metabolic acidosis (including diabetic ketoacidosis), or history of lactic acidosis
• Type 1 diabetes
• Excessive alcohol intake (acute or chronic)
• Severe hepatic dysfunction (liver disease) due to increased risk of lactic acidosis
• Conditions associated with low oxygen states (for example, cardiovascular collapse/shock or severe cardiorespiratory insufficiency)
• Severe dehydration or shock
• Pregnancy and breastfeeding

Invokamet may also need to be temporarily stopped around iodinated contrast imaging procedures and some surgeries due to kidney and lactic acidosis risk.

Serious Warnings You Should Know

Lactic acidosis (metformin-related)

Lactic acidosis is rare but serious and can be life-threatening. Risk increases with kidney impairment, dehydration, severe infection, heavy alcohol use, liver disease, and low oxygen states. Seek urgent medical care if you develop symptoms such as unusual tiredness, muscle pain, trouble breathing, stomach pain, severe nausea/vomiting, dizziness, or feeling cold.

Diabetic ketoacidosis (SGLT2-related, sometimes with normal or only mildly elevated glucose)

SGLT2 inhibitors have been associated with diabetic ketoacidosis (DKA), including cases where blood sugar is not extremely high. Stop the medication and seek urgent care if you have symptoms such as nausea, vomiting, abdominal pain, difficulty breathing, confusion, unusual sleepiness, or excessive thirst—regardless of your glucose reading.

Lower limb amputation risk (canagliflozin)

An increased risk of lower limb amputation was observed in large trials of canagliflozin. Risk may be higher in people with prior amputation, peripheral artery disease, neuropathy, or foot ulcers. Patients should practice routine foot care and report new pain, sores, ulcers, or signs of infection in the feet/legs promptly.

Volume depletion, low blood pressure, and kidney effects

Canagliflozin can cause increased urination and fluid loss. This may lead to dizziness, lightheadedness, low blood pressure, or kidney problems—especially in older adults, people with reduced kidney function, or those taking diuretics or certain blood pressure medicines. Staying hydrated matters, especially during hot weather or illness.

Serious genital/perineal infections (rare)

SGLT2 inhibitors can increase the risk of genital yeast infections and urinary tract infections. Rarely, a serious infection called necrotizing fasciitis of the perineum (Fournier’s gangrene) has been reported. Seek urgent care for pain, tenderness, redness, or swelling in the genital or perineal area, especially with fever or feeling unwell.

Common Side Effects

Side effects can come from either component (canagliflozin or metformin). Commonly reported or expected effects include:

• Stomach-related effects (especially when starting): diarrhea, nausea, vomiting, abdominal discomfort, gas, decreased appetite
• Increased urination or urinary frequency
• Urinary tract infections
• Genital yeast infections (vulvovaginal yeast infections; balanitis/balanoposthitis in males)
• Thirst

Metformin can also reduce vitamin B12 levels over time. Some patients may need periodic B12 monitoring, especially with long-term use or symptoms of deficiency.

Hypoglycemia: When It’s More Likely

Invokamet on its own is less likely to cause low blood sugar than insulin or sulfonylureas. However, the risk of hypoglycemia increases when Invokamet is used with insulin or an insulin secretagogue (like a sulfonylurea). Your prescriber may adjust other diabetes meds when Invokamet is added.

Monitoring and Precautions

• Kidney function: check before starting and periodically. More frequent checks may be needed if eGFR declines.
• Hydration and blood pressure: especially in older adults and those on diuretics.
• Feet and skin: routine foot care and early reporting of sores or ulcers.
• Ketone risk during illness: discuss sick-day rules with your clinician; surgery or severe illness may require temporarily stopping Invokamet.
• Vitamin B12: periodic monitoring may be considered with long-term metformin.
• LDL cholesterol: canagliflozin can increase LDL; your clinician may monitor lipids.

Drug and Procedure Interactions (Practical Highlights)

• Alcohol: avoid heavy use; it increases lactic acidosis risk with metformin.
• Iodinated contrast (CT dye): Invokamet may need to be stopped around the time of certain contrast studies and restarted only when kidney function is confirmed stable.
• Surgery: may need temporary discontinuation (your clinician will advise timing).
• Diuretics and blood pressure meds: can increase dehydration/low blood pressure risk.
• Insulin or sulfonylureas: higher hypoglycemia risk; dose adjustments may be needed.

How Invokamet Compares to Other Type 2 Diabetes Medications

Invokamet combines two common “foundation” approaches in type 2 diabetes: metformin plus an SGLT2 inhibitor. Compared with other options:

• Metformin alone: often first-line, low hypoglycemia risk, but may not be enough by itself.
• Other SGLT2 inhibitors: Invokamet’s SGLT2 component is canagliflozin; the class has similar mechanisms, but individual warnings and coverage can differ.
• GLP-1 receptor agonists: often helpful for weight and A1c lowering; many are injectable (some oral options exist). Some patients use both an SGLT2 inhibitor and a GLP-1.
• DPP-4 inhibitors: generally well tolerated but may lower A1c less than SGLT2/GLP-1 options in some patients.
• Sulfonylureas: inexpensive but higher hypoglycemia risk and possible weight gain.
• Insulin: powerful glucose lowering; higher hypoglycemia risk and requires injection training.

Your prescriber chooses therapy based on A1c goals, kidney function, cardiovascular/renal risk, weight goals, side effect tolerance, and affordability.

Buying Invokamet from Canada: Why Americans Look North

Many Americans look to Canada for cheaper medications because Canadian pricing is regulated differently than in the U.S. If your copay is high, your plan doesn’t cover your preferred option, or you’re paying cash, buying from Canada may be a cost-saving strategy.

Over The Border Meds is a Canadian prescription referral service that helps eligible U.S. patients access medications from Canada with a valid prescription. If you’re considering Invokamet from Canada, it helps to confirm your:

• Current dose (tablet strength and twice-daily schedule)
• Recent kidney function results (eGFR)
• Other diabetes medications (especially insulin or sulfonylureas)
• Sick-day plan for vomiting, dehydration, or surgery

To learn more about buying from Canada and options for cheaper medications, visit: Over The Border Meds

Disclaimer

This information is for educational purposes only and does not replace medical advice. Do not start, stop, or change your medication without guidance from a licensed healthcare professional. Seek urgent care for symptoms of diabetic ketoacidosis, lactic acidosis, severe allergic reaction, severe infection, or significant dehydration.

Reference: Invokamet Product Monograph (Canada)

Invokamet is typically taken twice daily with meals, as prescribed by your doctor. Swallow the tablets whole with water, and take them at the same times each day to help maintain steady blood sugar control. Always follow your healthcare provider’s instructions regarding dosing, hydration, and monitoring for side effects.