Background

If you have type 2 diabetes (T2DM), you are probably aware of how many antidiabetic medications exist on the market. Jardiance (empagliflozin) and Invokana (canagliflozin) are two of these products that are both popular and effective. These medications are FDA-approved to treat T2DM in addition to diet and exercise. Both of these medications are sodium-glucose cotransporter-2 (SGLT2) inhibitors. They block the SGLT2 protein in the kidneys, thereby helping the kidneys remove blood sugar from the body and into the urine. While both medications have similar mechanisms, they vary in terms of important characteristics. This article will discuss the similarities and differences between Jardiance and Invokana.

Indications

Both Jardiance and Invokana can be used to improve blood sugar and control T2DM in addition to diet and exercise. However, these medications differ in terms of what other conditions they treat. The table below outlines the differences.

Jardiance Invokana
  • Improves blood sugar control in T2DM in addition to diet and exercise
  • Lowers the risk of cardiovascular (CV) death in those with T2DM and CV disease
  • Improves blood sugar control in T2DM in addition to diet and exercise

  • Lowers the risk of a major CV event in those with T2DM and heart disease

  • Lowers risk of developing end-stage kidney disease, CV death, serum creatinine doubling, and heart failure hospitalization in those with T2DM and diabetic nephropathy with albuminuria

It is important to note that neither Jardiance nor Invokana can be used in the treatment of type 1 diabetes mellitus (T1DM) for diabetic ketoacidosis.

How they are taken

Jardiance Invokana
  • The dose is 10 milligrams (mg) once daily in the morning. It can be taken with or without regard to food. The dose can be increased up to 25 mg.
  • The starting dose is 100 mg once daily taken before the first meal of the day. The dose can be titrated up to 300 mg for those that tolerate a 100 mg dose.

Side effects

Side effects of Jardiance and Invokana that are similar include urinary tract infections (UTI), increased urination, and thirst. Comparisons of the side effects and frequencies are outlined below.

Side Effect Jardiance Invokana
Urinary tract infection Yes 9% (females), 4% (males) Yes 6%
Dyslipidemia Yes 4% Yes 2-3%
Increased thirst Yes 2% Yes 2-3%
Nausea Yes 2% No N/A
Increased urination Yes 3% Yes 5%
Genitourinary fungal infection Yes 2-6% Yes 11-12% (females), 4% (males)
Abdominal pain No N/A Yes 2%
Constipation No N/A Yes 2%
Severe allergic reaction Yes <1% Yes 4%
Increased serum potassium No N/A Yes 1-9%

Warnings and precautions

Patients and providers should use Jardiance and Invokana with caution in certain conditions. Invokana shares most of the same precautions as Jardiance. However, Invokana has additional warnings for lower limb amputation and risk of bone fracture. The table below compares the warnings for each drug.

Side Effect Jardiance Invokana
Ketoacidosis: Ketoacidosis occurs when the body breaks fat down too quickly. This produces ketones that make the blood acidic. Yes Yes
Volume Depletion: With volume depletion, patients can develop acute kidney injury. Patients at increased risk include the elderly, those with impaired kidney function, and those on diuretics. Yes Yes
Urosepsis: Patients may be susceptible to infections of the urinary tract. Yes Yes
Low blood sugar: Individuals on insulin products concomitantly with these agents may experience very low blood sugar. Yes Yes
Necrotizing fasciitis of the perineum: Patients are at risk of genital area infections. Yes Yes
Genital mycotic infections: Patients are at risk of genital infections. Yes Yes
Hypersensitivity reactions: There are reports of severe allergic reactions. Yes Yes
Lower limb amputation: Lower limb infections and foot ulcers can lead to amputation. No Yes
Bone fracture: An elevated risk of bone fracture has been observed. No Yes

Drug interactions

Both medications have similar drug interactions. However, Invokana has potential interactions with UGT enzyme inducers and digoxin that is not present with Jardiance. The table below compares potential drug interactions for each medication.

Drug Interaction Jardiance Invokana
UGT Enzyme Inducers: UGT inducers include drugs such as rifampin, ritonavir, phenobarbital, and phenytoin. Adjust the dose if taking concomitantly. No Yes
Digoxin: When co-administered with digoxin, the drug can increase digoxin concentrations. Use caution when taking concomitantly and monitor appropriately to avoid digoxin toxicity. No Yes
Positive Urine Glucose Test: SGLT2 inhibitors can elevate glucose excretion in the urine. This phenomenon will cause positive urine glucose tests if administered. Therefore, do not use urine glucose tests to monitor glycemic control. Yes Yes
Interference with 1,5-anhydroglucitol (1,5-AG) Assay: The 1,5-AG assay is not a reliable form of glycemic control monitoring in patients taking these medications. Other methods should be implemented to monitor glucose control in patients taking SGLT2 inhibitors. Yes Yes
Diuretics: Concomitant use with diuretics can cause volume depletion. Yes Yes
Concomitant Use of Insulin Products: These can cause low blood sugar when used in combination with other products that lower blood sugar, such as insulin. Dose adjustments to insulin may be required. Yes Yes

Use in specific populations

It is important to take caution when starting a new medication in certain patient populations, such as those who are pregnant. The table below outlines data available on the use of Jardiance and Invokana in certain types of patients.

Patient Type Jardiance Invokana
Pregnancy There is a potential risk to fetuses when using Jardiance, specifically in the 2nd and 3rd trimesters. There is a potential risk to fetuses when using Jardiance, specifically in the 2nd and 3rd trimesters.
Breastfeeding Jardiance should not be used while breastfeeding. Invokana should not be used while breastfeeding.
Elderly Elderly patients are more susceptible to side effects such as volume depletion and decreased kidney function. Elderly patients are more susceptible to side effects such as volume depletion.
Kidney impairment Those with kidney impairment have an increased risk of certain side effects. Those with kidney impairment have an increased risk of certain side effects, such as low blood pressure.
Liver impairment Not applicable Invokana is not recommended in those with serious liver problems.

Conclusion

Though similar, Jardiance and Invokana have slight differences. As a patient, consider these differences when discussing with your doctor the best treatment option for your diabetes.