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Diabetes affects tens of millions of Americans with the number growing alarmingly rapidly. Invokana represents a new concept in therapy. Rather than stimulating the body’s metabolism of sugar, this drug leads to elimination of glucose through the kidneys into the urine. Relatives include Jardiance and Farxiga. Recent concerns suggest some association with kidney failure, bone fractures, ketoacidosis, genital yeast infections and possibly an increased risk of amputations. Cash price may exceed $15 each day.

Hello i’m dr. ken landon let’s talk about treating diabetes and specifically using a drug known as invokana diabetes obviously very common condition about 3540 million people in the united states with diabetes and we seem to be losing the battle as the waistline increases so does the likelihood of developing diabetes there are about 52 million people in the united

States with pre-diabetes current trajectory those people will be diabetic if they don’t do something we spend about 350 billion dollars to take care of diabetes in the united states and we’re not doing a very good job it’s estimated by the centers for disease control that probably somewhere around one person in nine has diabetes and one person in three has prediabetes

Now we have a relatively new pill it’s known as invokana it was the first in its class it was originally developed by a japanese concern licensed to an american company jensen pharmaceuticals owned by johnson & johnson approved for marketing in march of 2013 different from other anti diabetes medicines it was going to be the second actually farxiga was going

To be the first but in 2012 or sicker ran into some problems at the food and drug administration with concern over liver damage and bladder tumor and breast tumors subsequently it’s been approved invokana was approved in march of 2013 to be taken before the first meal of the day and the way it works is it hasn’t changed the insulin level of the body or any of the

Other hormones it simply makes the kidneys pass out the sugar through the urine well the approval of all of these drugs any drug doesn’t matter what the drug is for diabetes it’s approved on the basis of how much it lowers the sugar and all of them lower their sugar basically by about the same amount unfortunately the food and drug administration doesn’t really pay

That much attention to what’s going to be the fate of people with diabetes or is it going to reduce the likelihood of them having a heart attack that’s obviously why most people with diabetes die it isn’t because the sugar is 200 it’s because the sugar or something is playing foul with the inside of the body so the way you take the drug is you take 100 milligrams

One pill before the first meal of the day assuming you have relatively good kidney function because remember the sugar is going to be passed out through the kidney and that’s the way the medicine works you can take it by itself or you can use it in addition to some other diabetic medicine and as a matter of fact it’s sold in a pill combined with metformin now it’s

Important to realize that about half of all of the people who take diabetes medicines are unsatisfied because they don’t reach the appropriate level of sugar control almost any of these medicines reduces the blood sugar or the glycosylated hemoglobin that we use by about the same amount if we look at the drop in blood sugar it’s about 30 points if we look at the drop

In the hemoglobin a1c it’s about eight tenths of one percent well these drugs aren’t necessarily the safest things in the world so it was approved as i said in 2013 and by 2015 the food and drug administration had advised it on at least four major concerns so after the approval they found that the drug increased the risk of bone fractures decrease in bone density

Especially of the spine in the hip it seems to increase the likelihood of fractures from minimal elevation from standing height it causes ketoacidosis a buildup of acid in the system it caused in some patients kidney failure and in some people they developed life-threatening infections over all the side effects are the same as with guardians guardians and farxiga and

Invokana all of the same family of drugs causes an increased amount of sugar going out in the urine the sugar is going to pull water and that means you’re going to urinate a lot so increase urination polyuria is a problem and that can lead to dehydration and especially dehydration if you’re on a lowe’s diet if you’re taking a diuretic maybe if you’re a relatively

Thin individual gonna increase your risk and then if you unfortunately develop dehydration hypovolemia not enough fluid circulating in the system so when you stand up you can become dizzy or faint or fall and then that obviously increases the likelihood of having a hip fracture or some other bone fracture and all that sugar going out in the urine can increase the

Risk that you’re going to develop a yeast infection generally east infection men and women both foul-smelling red swollen area unfortunately relatively common hypersensitivity reactions hives nordic areas sometimes the skin falling off all not uncommon and then in the first 30 days of taking the drug there’s increased incidence by about 50% of developing a stroke

Probably because of the dehydration maybe because of some other reason we know that that’s not uncommon to find problem so avandia had been on the market for about nine years before it was found to increase the risk of heart attacks when i mentioned ketoacidosis what is it it’s an elevation of your blood sugar an elevation of your blood acid that causes symptoms

Like nausea and vomiting abdominal pain shortness of breath and malaise tiredness you are predisposed to it if you’re a good fair amount of alcohol maybe have some pancreatic disease or maybe you’ve just become ill with something else maybe you’ve cut down the amount of fluid the amount of calories you take in maybe you have some kind of febrile condition and we

Know that it can lead to kidney problems and kidney failure and people who take this drug can have an increase in their cholesterol an increase in their potassium and we know that even though it’s not marketed specifically as a weight-loss drug we know if you’re losing a lot of sugar well sugar is calories so you’re going to lose some weight maybe about three percent

Of your body weight can be lost taking these drugs and even though it’s not a blood pressure pill it seems that when the sugar goes out and takes the water with it also takes sodium with it and as a result the blood pressure can go down so it may well be that this kind of medicine is good for long-term survival because it treats your obesity and it treats your blood

Pressure well johnson johnson was told hey after you get approval for this drug you better do some studies you better look and see what happens over a period of the next four years as far as heart disease and liver disease and cancer and pancreatic diseases concern all very good idea of course and they were shocked to learn just may 18 2016 so just very recently

It was found first by the european regulators then by the american authorities that invokana might actually increase the risk of amputations and it seems like it increases risk of amputations by 2 or 3 fold over people taking a placebo maybe because they’re dehydrated maybe because there’s not getting enough flow of blood to the tissue there is another study that

Only lasted nine months the one i talked about canvas study lasted a year well in the subsequent study over a period of nine months maybe there wasn’t the increase in amputation and there’s no direct cause-and-effect link that so far has been established but we know people with diabetes have a higher risk of developing foot ulcers at some period in time that 15%

Ultimately you’re going to get problem like that that increases the risk of the amputations anyway so the food and drug administration says hey you have to saw you have an infection you have an ulcer especially about the extremity go and talk to your doctor and we know that if you happen to have type 1 diabetes the juvenile onset diabetes the diabetes associated

With the lack of insulin in your body well that increases risk of that ketoacidosis so it’s only for type 2 diabetics now the head of the yale university school of medicine diabetes center he says we can treat you for a month for four bucks or we can use some of these new pills that cost nine ten eleven $17 a pill and as a matter of fact even though the price

Is a hundredfold greater on some of the medicines you don’t get a hundred percent more benefit 100 times more benefit you just don’t as a matter of fact the benefit seems to be basically the same how much does this drug cost well if you take invokana and you pay cash for it it’s about 17 dollars a pill if you go and have a coupon maybe it’s somewhat less now they

Have a savings card the company makes savings card and they say that if you take this in then you don’t have to pay the copay or you pay a reduced copay but some people say and some authorities say hey that’s not ethical that’s not appropriate so you can’t use that if you have medicare can’t use it if you have medicaid can’t use it if you have tricare and if you

Go online to invokana you’ll find an enormous number of lawyers advertising for all of the different kind of lawsuits against the company so when it comes to diabetes how should you treat it number one is diet number two is exercise and then have a long talk with your doctor about whether all of these new very expensive drugs are really going to benefit you more

Than taking some of the older very inexpensive generics anyway something for you to consider i’m doctor ken landau thank you for watching you

Transcribed from video
Invokana By wellnowdoctor