New Metformin Combo Drug Approved for Type 2 Diabetes

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.

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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.

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