Diabetes Self-Management Blog

On August 8, the U.S. Food and Drug Administration approved the oral combination medicine canagliflozin/metformin (brand name Invokamet) for Type 2 diabetes. Invokamet, manufactured by Johnson & Johnson subsidiary Janssen Pharmaceuticals, combines the SGLT2 inhibitor canagliflozin with the commonly prescribed diabetes drug metformin. Invokamet is the first medicine to combine an SGLT2 inhibitor and metformin available in the United States.

In the process of filtering the blood, the kidneys typically reabsorb all the filtered glucose and return it to the bloodstream. One of the main proteins responsible for this reabsorption is SGLT2. By inhibiting the action of SGLT2, canagliflozin blocks the reabsorption of glucose by the kidneys, promoting a loss of glucose in the urine and lowering blood glucose levels. Metformin works by decreasing glucose production by the liver, as well as improving insulin sensitivity in the liver, muscle, and fat cells.

Invokamet tablets are approved for use in conjunction with diet and exercise in adults with Type 2 diabetes whose condition is not sufficiently controlled with either canagliflozin or metformin alone or who are already taking both medicines. Studies of Invokamet indicated that taking the medicine was equivalent to taking corresponding doses of canagliflozin and metformin as individual tablets.

Invokamet comes in tablet strengths containing 50 milligrams or 150 milligrams of canagliflozin and 500 milligrams or 1,000 milligrams of metformin, to be taken twice daily.

This medicine should not be used to treat Type 1 diabetes or diabetic ketoacidosis (a potentially life-threatening condition marked by a chemical imbalance in the body).

The most common side effects of canagliflozin are female genital fungal infections, urinary tract infections, and increased urination, while the most common side effects of metformin are diarrhea, nausea and vomiting, flatulence, lack of energy, indigestion, abdominal discomfort, and headache. Like metformin alone, Invokamet carries a small but serious risk of lactic acidosis (a potentially fatal condition in which lactic acid builds up in the blood, depriving the body’s tissues of oxygen).

For more information, see the press release on the Johnson & Johnson website.


  1. What about insurance companies? Are they covering it or are they going to make you pay an tremendous amount for it? Victosa works for me but insurance won’t pay for because of the cost.

    Posted by Cindy Baker |
  2. NO thanks these new drugs …female genital fungal infections, urinary tract infections who need that? We have enough problems!

    Posted by pat |
  3. I was taking off Metformin , was up to 1000milg..it was affecting my pencreas ..I got acute pencreasitis . I feel better with out it… and Metformin does have other side effects other then diarrhea, headaches. IT ALSO AFFECT my mother, she could walk for days taking it… ..I will not go back to metformin again…..

    Posted by zuly |
  4. Ohh and i dont drink so doctors where surpise that i got pencreasitis..

    Posted by zuly |
  5. I just read an article that there is a cure for diabetes. Its the Ketogentic diet. No wheat or sugar or flour products. I am trying to do it but hard during the summer months with all the get togethers.
    What do you all think??

    Posted by brandy |
  6. @brandy

    That is not a cure if you seriously think about it. You are inhibiting all your carbohydrates intake by not eating wheat or sugar products. If you can carry on such a diet, you will lose weight and your dependence on insulin will diminish to a level that you will not need any additional medication.

    But consider this as well: the stuff you eat outside these groups of foods you mentioned, have carbs hidden in them. Eaiting a medium size apple gives you sugar equivalent of about a 1/4 can of regular soda. And your body needs insulin to break it down for all intents and purposes.

    I am not sure where you read this information, but from the way you worded your claim, as in “cure for diabetes” and the following support statement “No wheat or sugar or flour products” is telling me that you’ve got this *news* from one of those sensation seeking health websites. I wouldn’t put too much thought into it if I were you. It is always a good idea to limit your carb intake for diabetics (and non-diabetic people as well in my opinion) but calling this a cure for diabetes is not the right way of putting it.

    Posted by Mel |
  7. I started seeing the TV ads for the Invokana drug lately on late night local TV shows. I am very curious about trying it, but I am wondering if it can help me as I have been injecting insulin for the past 7 years or so and at increasing amounts. My daily intake nowadays is about 80 units of rapid acting (before meals spread throughout the day) and about 60 units of slow acting variety (before bed time) My doctor found this very unusual and high dose.

    Has there been a study performed regarding the use of this pill on insulin dependent Type-2 diabetics ?

    Posted by Mel |
  8. Invokamet isn’t the first to combine metformin and another diabetes drug. Ever heard of Januvamet? I’ve been taking it for a long time.

    Posted by Susan |
  9. Hi Susan,

    Thanks for your comment. You are correct that Invokamet isn’t the first medicine to combine metformin with another diabetes drug. It is, however, the first medicine to combine metformin with a diabetes drug from the class of medicines known as SGLT2 inhibitors.

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  10. Mel I want to eat so that I don’t have to take all the drugs that are being made to control diabetes. I beleive in a more natural way of controling this disease instead of relying on drugs.

    Posted by brandy |
  11. I am not a fan of combo drugs, especially with the many side effects and added expense associated with them. The problem as I see it, is that by taking this new drug combo, you would deliberately expose yourself to a UTI and the subsequent need for an antibiotic. There is an epidemic of overusing antibiotics now. Isn’t it safer to adopt a low carb diet and exercise program first? Then there would be less sugar circulating in your blood stream for your body to dispose of–then to rely on this crutch.

    Posted by Mary G |
  12. I see your points @brandy and @MaryG. Of course eating healthy is the best thing to do. But if you come to think of it, this is no an easy feat. Natural food tastes like crap. We are creatures of taste and pleasure. If all I am going to eat is the raw vegetables and meat without (or in miniscule amounts of) any salt and god-forbid sugar, will not take any carbs into my system, in short, not enjoying the rest of my life, what is the point ? Like the joke:

    The middle aged man goes to the doctor’s office for his yearly checkup and asks the doctor:

    -Hey doc, I want to live to see my 100th birthday, what do you think I should do ?

    Doctor answers:
    -Quit smoking, give up sex and don’t eat any food but organic vegetables and very little meat.

    The guy’s eyes sparkle and asks:
    -If I do all of these, will I live for 100 years ?

    Doc rolls his eyes and answers:
    -Even if you don’t, it will “feel” that way.

    So, after all, I am all for the healthy living gig but every once in a while, people should enjoy their lives. Yes, side effects of any drug is nothing to dismiss but if I am going to (pardon my language) fart a little, to enjoy a slice of pizza, sorry, but pinch your nose if you are in my vicinity :)

    Posted by Mel |
  13. My Dr started giving me Glimepiride 2 mg added to the Metformin to bring down my Sugar level that Stress has caused to rise about-I asked him when I could get off some of these meds and he said when I loose weight. I do not eat any white bread or white rice because I was told that the brown bread & rice was healthier & digest slower. Now I read where we should not eat any Grains. Have you heard of the medicine that I was given to take along with the Metformin and if Diabetics should refrain from any Grains? I have type 2 Diabetes.

    Posted by Robert M |
  14. I’ve been taking Metformin 1000mg twice a day for 3 yrs. I’ve also been taking Glipizide 10mg twice a day with the Metformin for the last year & half. When I started taking both (& any time I stopped taking them regularly), I had ALOT of nausea, gas, diarrhea, & headaches. I still have them but as long as I take them both regularly, it is not as bad or as frequently.

    Posted by Tracey Scott |
  15. and what about those with kidney disease every new drug on the market has side effects way beyond you need to be completely healthy to take them but then of course you wouldn’t need them have you ever taken a look at the no no list for chronic kidney disease i think just about the only thing it does allow is flour tortillas eggs and mushrooms lol

    Posted by marylittle |
  16. I have to say that I’m taking metformin, januvia, & glimiperide … in addition of 30 units nightly of lantus and my sugars are still all over the place. My stress levels are high, which doesn’t help. Eating 1 or 2 times a day also doesn’t help. Most times I’m not hungry. I watch my carbs and interchanges and I’m not sure what else to do at this point.

    Posted by Maricela |
  17. I still think the key factor is excercise. Yes what kinds of foods we eat are esential however, I sit behind a desk ALL DAY. I do not get enough exercise. I went on vacation to see my son and we were busy all day long, fishing, walking thru town shopping. the entire time I was there i took my pills but never once in that entire week did I require insulin.. my sugars were between 85 & 95 the entire time. So it is not all food, we need to get up off our butts and move as well…. Im now taking the Invokana, Metformin and Lantus @ nite. and when I sit behind my desk all day my Blood sugars run 120 ish…..

    Posted by Donna M |

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