Pharmacy Services

Canagliflozin (Invokana®, Invokamet®) Can Decrease Bone Mineral Density and Increase Fracture Risk

September 14, 2015

The sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin (Invokana®, Invokamet®) may decrease bone mineral density and cause fractures. Canagliflozin is used to lower blood sugar in patients with type 2 diabetes. In clinical trials canagliflozin was associated with decreased bone mineral density at the hip and lower spine and an increased risk of fractures compared with placebo. Fractures occurred as early as 12 weeks after initiation of therapy and often involved only minor trauma, such as falling from standing height. FDA issued a MedWatch safety communication and changed the drug label to strengthen its warning of this adverse event. FDA is evaluating the other SGLT2 inhibitors for similar risk.

Instruct patients to read the Medication Guide provided with each prescription of canagliflozin. Patients should not stop canagliflozin before discussing options with their healthcare provider. Consider other risk factors for fracture when prescribing canagliflozin. Report adverse events with canagliflozin or other SGLT2 inhibitors to the FDA MedWatch program.

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Updated
September 14, 2015; University of Utah, Drug Information Service. Copyright 2015, Drug Information Service, University of Utah, Salt Lake City, UT.