Monday, April 22, 2013

A new diabetes medication ,Canaglifloxin ( Invokana ) To take or not to take is a question

My opinion
 New diabetes medications are generally welcome tools for our patients with diabetes. This new medication , Canaglifloxin ( Invokana ) , will not be added to my tool box until more safety data is available . It just has to many real and potential problems . I have added two quotes for you to consider.

 "So, this is not a drug I'd be enthusiastic about," 
     Dr David M Nathan ,Endocrinologist  ( Harvard Medical School ) 

" I'm not sure yet it's 100% okay, so I voted no," 
            Dr William R Hiatt  , cardiologist currently on the FDA panel

I have added a link below for more information . Read the side effects and precautions. Choosing the right patient for this medications and following patients , especially over age 65, will not be easy.

How does Invokana work ?
  It blocks the reabsorption of glucose in the kidney allowing glucose and fluids to spill into the urine.

Things to consider

Yeast infections
 The increase loss of glucose in the urine increases the frequency of urinary tract infection and a 4 to 7 fold increase in mycotic infection ( yeast infection ) in men and women .

 Increased fluid loss
   Increases postural hypotension ( low BP when standing ) and syncope especially in  older people
   ( age 65 + - ) .
   The normal process of aging is often associated with a  mild , often undetected , decrease in kidney  
   function . This medication may contribute to the problem . 

 Cardio vascular risk is still not determined
     - 46 % increase in strokes in one study within the first 30 days of use
     - increase LDL cholesterol 
     - increase non -HDL  cholesterol
     - increase serum potassium that could effect heart rhythm . This is dose dependent and is worse in
       patients  taking ACE Inhibitors  ( Angiotensin converting enzyme inhibitors ) and ARB 
      ( angiotension receptor blockers ) . These two medications are commonly used to lower BP and 
       protect kidneys for patients with diabetes .
     - increase digoxin levels for patients on digoxin ( digoxin is  cardio-toxic at  high levels )
 None of the above problems are good and the regular consistent followup of patients kidney function , potassium  and digoxin levels will add another level of difficulty to an already complex management problem .

Have Fun , Be smart and be sure you have reviewed and discussed all of the side effects of the medication with your doctor before adding it to your treatment program.
  David Calder , MD

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Your comments and questions are appreciated. David Calder,MD