Short answer: Invokamet combines canagliflozin, the drug in Invokana, with metformin.12 Invokana is 100 mg once daily before the first meal, up to 300 mg. Invokamet is taken twice daily with meals, or as Invokamet XR, two tablets with the morning meal. Both are approved from age 10 for blood sugar and share heart and kidney uses in adults with type 2 diabetes. Only Invokamet has a boxed warning, for lactic acidosis.
| Invokana | Invokamet | |
|---|---|---|
| What it contains | Canagliflozin, an SGLT2 inhibitor1 | Canagliflozin and metformin2 |
| How taken | Once daily before the first meal of the day1 | Invokamet twice daily with meals; Invokamet XR two tablets once daily with the morning meal, swallowed whole2 |
| Dose | 100 mg, up to 300 mg for blood sugar with an eGFR of 60 or more; 100 mg for heart and kidney uses1 | Usually canagliflozin 100 mg a day to start, up to 300 mg; metformin up to 2,000 mg a day2 |
| Kidney limits | Up to 100 mg at an eGFR of 30 to under 60; not started below 30, though some people with heavy albuminuria may continue 100 mg1 | Not started below an eGFR of 45; up to 100 mg canagliflozin at 30 to under 60; not used below 302 |
| Side effects in label trials | Female genital yeast infection 10.6% on 100 mg vs 2.8% on placebo, more urination 5.1% vs 0.7%1 | Same pool; when both drugs were started together, diarrhea 4.2% vs 1.7% on either alone2 |
| Boxed warning | None1 | Lactic acidosis2 |
Both labels carry the canagliflozin warnings: ketoacidosis, lower limb amputation, fluid loss, urinary and genital infections including Fournier's gangrene, low blood sugar with insulin or a sulfonylurea, allergic reactions and bone fracture.12 In the CANVAS trial reported in the Invokana label, 3.3% of people on canagliflozin had an amputation vs 1.5% on placebo over a mean of 5.7 years.1 Invokamet adds the metformin warnings: lactic acidosis and lower vitamin B12, and stops around some contrast scans.2 Both say to hold it for at least 3 days, if possible, before surgery with long fasting.12
Which, if either, fits is for your prescriber. More detail: Invokana side effects, Invokamet side effects, the Invokana and Invokamet dosing schedules, the Invokana missed-dose page, and Xigduo XR vs Invokamet: how do the two SGLT2 and metformin tablets differ?.