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The following safety information outlines crucial warnings and potential risks associated with Invokana (canagliflozin). It is important to review this information thoroughly and discuss any concerns with your healthcare provider.

• Leg and Foot Amputations: There is a rare risk of leg or foot amputations with Invokana. This risk increases for individuals with a history of amputation, blood vessel issues, nerve problems, or diabetic foot ulcers. Common causes for amputations include leg infections and damaged tissue. Report any new leg or foot pain, sores, ulcers, or infections to your healthcare provider immediately. Regular foot examinations are advised to prevent complications.

• Ketoacidosis: Invokana may lead to ketoacidosis, a potentially life-threatening condition where excessive ketones make the blood acidic. The risk is higher for those with type 2 diabetes, reduced calorie intake, higher Invokana doses, recent surgeries, or insulin dose adjustments. Symptoms include dry mouth, fruity breath, fatigue, nausea, vomiting, abdominal pain, and breathing difficulties. Seek urgent medical attention if these occur.

• Dehydration and Low Blood Pressure: This medication can cause dehydration, leading to low blood pressure or kidney injury. Risks are elevated for individuals over 65, those with kidney issues, on a low-sodium diet, or taking loop diuretics. Ensure adequate hydration and notify your provider if you experience dizziness, reduced urination, vomiting, or diarrhea.

• Genital and Urinary Tract Infections: Invokana increases the likelihood of genital infections, such as UTIs and yeast infections, which can sometimes become severe. Contact your provider if you experience burning during urination, frequent urination, lower abdominal pain, blood in urine, unusual genital odor, or redness and tenderness in the genital area.

• Hypoglycemia with Other Diabetes Medications: There is an increased risk of low blood sugar when Invokana is used with other diabetes medications like insulin or sulfonylureas. Symptoms include nervousness, shakiness, sleepiness, weakness, confusion, rapid heartbeat, sweating, and hunger. Monitor blood sugar levels if these symptoms arise.

• Severe Allergic Reactions: Rarely, Invokana can cause severe allergic reactions. If you develop a rash, difficulty breathing, or swelling of the face, lips, tongue, or throat, seek immediate medical help.

• Bone Fractures: There is an elevated risk of bone fractures within three months of starting Invokana. Discuss bone health strategies with your healthcare provider.

Contraindications: Do not use Invokana if you are on dialysis, as it may pose serious health risks. Always consult with your healthcare provider if you have concerns about using this medication.

When taking this medication, you might notice some common side effects such as frequent urination, a dry mouth, dizziness, and lightheadedness. These symptoms are generally mild, but if they persist or worsen, it's important to consult with your healthcare provider. Vaginal yeast infections and urinary tract infections are also possible, with some individuals experiencing increased thirst, nausea, or constipation. Male patients may notice genital yeast infections, which could cause itching or discomfort.

For more serious side effects, immediate medical attention is crucial. These include signs of a bladder infection, such as fever and burning during urination, or indications of kidney issues, like changes in urine output or swelling in the legs and feet. Another serious concern is high potassium levels in the blood, which might manifest as muscle weakness or irregular heartbeat.

In rare cases, this medication could lead to dehydration or a serious bacterial infection in the genital area, known as Fournier's gangrene. Watch for symptoms like pain, redness, or swelling around the genitals, along with fever or an overall feeling of being unwell. Additionally, there's a slight risk of increased ketone levels in the blood, which can cause symptoms such as nausea, vomiting, and trouble breathing.

While low blood sugar is uncommon with this medication alone, it can occur when combined with other diabetes drugs, insufficient food intake, or heavy exercise. Symptoms include sudden sweating, shaking, and fast heartbeat. Carry glucose tablets or fast-acting sugar sources as a precaution, and seek guidance if symptoms arise. Lastly, there's a rare risk of allergic reactions, characterized by a rash, breathing difficulties, or swelling of the face and throat, necessitating urgent care. Always stay hydrated to prevent dehydration, and discuss with your doctor if you experience any unexpected effects for proper management.

When managing your medications, it's crucial to be aware of potential interactions. For instance, beta-blockers, including medications like metoprolol, Propranolol, and certain eye drops for glaucoma such as Timolol, can mask the rapid or pounding heartbeat symptom of low blood sugar (hypoglycemia). However, these drugs do not affect other low blood sugar symptoms like dizziness, hunger, or sweating. It's important to regularly check your blood sugar and discuss any changes in medication with your healthcare provider, as many drugs can impact your blood sugar levels. If you experience symptoms of high or low blood sugar, inform your doctor immediately, as adjustments to your diabetes treatment plan may be necessary. Additionally, this medication might interfere with lab tests, such as urine glucose tests, leading to inaccurate results. Ensure your healthcare team is aware of all medications you are taking.

For Invokana (canagliflozin), it's essential to inform your doctor and pharmacist about all other medications and supplements you're using, including over-the-counter drugs, vitamins, and herbal supplements, as this can help avoid interactions. Some medications listed below may require special caution when used with Invokana. If prescribed together, your doctor might need to adjust the dosage or frequency. Medications such as Balofloxacin, Ciprofloxacin, Digoxin, and Flumequine, among others, are known to interact with Invokana. Additionally, combining Invokana with certain beta-blockers like metoprolol and timolol could increase the risk of side effects, although these combinations might be necessary for effective treatment. Always consult your doctor to ensure safe use of these medications.