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A new medication called Invokana (canagliflozin) holds the promise of lowering blood sugar levels in a way that complements rather than replacing existing drugs. The side effects of the drug, however, may outweigh its benefits.

The latest tool in mainstream medicine's war on diabetes is a medication developed by Mitsubishi Tanaba Pharmaceticals, licensed in the United States by Janssen Pharmaceuticals. and manufactured by Johnson & Johnson Pharmaceuticals known as Invokana. The generic name of the drug is canafliflozin. Invokana is the first of a new class of diabetes drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitors.

First Diabetes Drug to Take Advantage of Sodium-Potassium Balance in Cells

Invokana is a drug designed to advantage of the fact that for insulin to transport glucose from the bloodstream into a cell, it has to transport sodium at the same time. For every molecule of sugar that goes into the cell, three ions of sodium have to tag along, while two ions of potassium have to be expelled.

The exchange of sodium and potassium creates a slightly positive charge inside the cell that "pulls in" the slightly negatively charged glucose from the bloodstream.  

Moving sugar out of the bloodstream into most cells in the body, of course, is a good thing, since diabetes is defined as a disease of high blood sugar levels. But moving sugar that has "spilled over" into the urine back into the filtering tubules of the kidneys is not.

The way Invokana works is by inhibiting a transporter protein that enables the movement of glucose and sodium together only in the filtering tubules of the kidneys.

Invokana's action is specific to the kidneys, stopping them from responding to the transporter molecule and allowing them simply to flush away excess sugar.

Just How Effective is Invokana?

Clinical trials have shown that taking Invokana lowers hemoglobin A1C (HbA1C) levels by an average of 0.6 to 0.7%, roughly corresponding to a reduction in "average" blood glucose levels of 10-12 mg/dl (about 0.6 mmol/L). This is a better blood glucose reduction than almost any other anti-diabetes drug on the market,

with the exceptions of insulin and metformin, although insulin and metformin produce much more dramatic reductions in average blood sugar levels. And unlike insulin and the older anti-diabetes medications that work by stimulating the pancreas to produce more insulin,

Invokana does not cause weight gain. In fact, clinical trials show that it may cause loss of up to 2 or 3% of body weight.

The retail price of Invokana has not been announced, but the wholesale price has been set at $8.77 per tablet, or $263.10 for a one-month supply. Consumers are not likely to have to pay more than $550 per month for the drug.

Sure, the medication is only slightly more effective than the $5 per month glipizide or Amaryl, or the $24.88 per vial Walmart brand of insulin, but what could possibly go wrong?

It turns out, a lot.

Continue reading after recommendations

  • Polidori D, Sha S, Mudaliar S, Ciaraldi TP, Ghosh A, Vaccaro N, Farrell K, Rothenberg P, Henry RR. Canagliflozin Lowers Postprandial Glucose and Insulin by Delaying Intestinal Glucose Absorption in Addition to Increasing Urinary Glucose Excretion: Results of a randomized, placebo-controlled study. Diabetes Care. 2013 Feb 14. [Epub ahead of print] PMID: 23412078
  • Yale JF, Bakris G, Cariou B, Yue D, David-Neto E, Xi L, Figueroa K, Wajs E, Usiskin K, Meininger G. Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes Obes Metab. 2013 Mar 6. doi: 10.1111/dom.12090. [Epub ahead of print]
  • Photo courtesy of Tracie Andrews by Flickr : www.flickr.com/photos/tracieandrews/11927167715/

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