A newer class of type 2 diabetes drugs called SGLT2 inhibitors are being credited in recent studies for reducing the risk of hospitalization due to heart failure in diabetic patients, but the news doesn’t overshadow the drug’s laundry list of risks. Patients considering treatment with an SGLT2 inhibitors, such as Invokana and Invokamet, should first consider the potentially life threatening side effects.
Invokana was the first SGLT2 inhibitor to hit the market in March 2013. Shortly thereafter, the Food and Drug Administration (FDA) issued a warning that the drugs had been linked to reports of ketoacidosis, a serious condition in which too much acid builds up in the blood. If left untreated, ketoacidosis can lead to diabetic coma and death. It is also referred to as diabetic ketoacidosis or DKA.
Invokana and other SGLT2 inhibitors work to lower blood sugar levels by flushing excess sugar through the kidneys and excreting it through the urine. Clinical trials showed that this process made users of the drugs more prone to urinary tract infections and kidney infections. Shortly after the drugs entered the market, the FDA strengthened the warnings for serious urinary tract infections, alerting doctors and patients that in some cases the infections could result in a serious blood infection called urosepsis, or a kidney infection called pyelonephritis.
This novel mechanism of SGLT2 inhibitors to process sugar through the kidneys also led the FDA to strengthen warnings for acute kidney injury (AKI) and kidney damage. This warning was exclusive to Invokana, Invokamet, Farxiga and Xigduo.
The FDA also issued a warning that Invokana and Invokamet could cause bone fractures, as well as lead to a loss in bone mineral density. The agency also announced that it was investigating whether people who use Invokana and Invokamet were at an increased risk of lower limb amputations.