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.
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.
How they are taken
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.
|Urinary tract infection||Yes||9% (females), 4% (males)||Yes||6%|
|Genitourinary fungal infection||Yes||2-6%||Yes||11-12% (females), 4% (males)|
|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.
|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|
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.
|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.
|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.|
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.