Adults with type 2 diabetes have several relatively new medication options to work with. Some of these, like Invokana, have been associated with a risk of kidney problems that patients need to be aware of.

What Is Invokana?

Invokana, or canagliflozin, is one of a class of drugs known as SGLT2 inhibitors. These diabetes medications are FDA-approved to reduce blood sugar in adults with type 2 diabetes.

Invokana and other drugs like it work by blocking the action of SGLT2, a protein in the kidneys that causes glucose to be reabsorbed into the blood. But that alteration of the normal function of the kidneys may be linked to certain side effects like urinary tract infections and Invokana kidney failure.

Invokana Kidney Failure

The FDA addressed the risk of Invokana kidney failure in a drug safety communication issued in May 2015. A review of the agency’s Adverse Event Reporting System revealed 19 cases of life-threatening blood infections and urinary tract infections that developed into kidney infections, all from March 2013 through October 2014.

Some of these patients required dialysis for kidney failure. In all cases, the patients had to be hospitalized, some in intensive care.

Also in May 2015, the Institute for Safe Medication Practices published a review of post-market information about Invokana in its QuarterWatch report.

QuarterWatch is a quarterly publication that monitors and reports on the FDA’s MedWatch reports – information submitted to the FDA through its Adverse Events Reporting System and released by the agency for public review.

QuarterWatch says that part of Invokana’s mechanism of action is to inhibit the kidneys’ normal function of returning glucose to the blood. Instead, Invokana causes the kidneys to excrete large amounts of glucose in the urine. The ISMP says that

The report notes that in the first year of adverse event data for Invokana, several reports were made addressing serious injuries involving kidney function. These injuries could have been reasonably anticipated, given Invokana’s mechanism of action and the data available from clinical trials, QuarterWatch says.

In the reports from Invokana’s first year on the U.S. market, QuarterWatch found five different types of adverse events related to the drug’s renal toxicity. These included dozens of cases of kidney failure and urinary tract infections, plus some cases of kidney stones.

The QuarterWatch report raised what it called “unanswered questions” about potential Invokana problems – specifically, whether in light of recent MedWatch data Invokana “has clinical benefits, and whether those benefits outweigh its risks.”

The authors say that at the time Invokana was approved by the FDA, it had not been tested in enough patients for a long enough period of time to determine whether it was clinically effective to reduce the risk of microvascular events like kidney damage.

Manufacturer Janssen Pharmaceuticals responded to QuarterWatch’s findings by saying its existing Invokana warning label already contains warnings about these adverse effects – except for kidney stones, about which the company says there is not enough information.

Patients who have suffered Invokana kidney failure or other Invokana problems may have a basis for seeking compensation for their troubles. Some Invokana lawsuits have already been filed, alleging the manufacturer failed to properly warn patients about the risks of Invokana problems.