Comparative Pharmacology
Head-to-head clinical analysis: INVOKAMET versus INVOKANA.
Peer-Reviewed Evidence
Head-to-head clinical analysis: INVOKAMET versus INVOKANA.
INVOKAMET vs INVOKANA
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
INVOKAMET is a combination of canagliflozin, an SGLT2 inhibitor, and metformin, a biguanide. Canagliflozin inhibits sodium-glucose cotransporter 2 in the renal proximal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity.
Sodium-glucose cotransporter 2 (SGLT2) inhibitor; reduces renal glucose reabsorption, increasing urinary glucose excretion.
Oral: Starting dose: 5 mg canagliflozin/500 mg metformin hydrochloride extended-release twice daily; titrate based on efficacy and tolerability, maximum 150 mg/1000 mg twice daily.
100 mg orally once daily, before the first meal of the day; may increase to 300 mg once daily if tolerated and eGFR is adequate.
None Documented
None Documented
Canagliflozin: 10–13 hours (multiple dosing); Metformin: 6.2 hours (plasma). Accumulation occurs in renal impairment.
Terminal elimination half-life is 10.6 hours (range 9.5–12.5 h) in healthy subjects; allows once-daily dosing. Half-life increases to 16 hours in moderate renal impairment and 22 hours in severe renal impairment.
Canagliflozin (SGLT2 inhibitor): ~33% renal (1% unchanged, ~33% as glucuronide metabolites), ~52% fecal. Metformin (biguanide): 90% renal unchanged via tubular secretion.
Primarily excreted unchanged in urine (33%) and feces (52%) as parent drug and glucuronide metabolites; renal clearance accounts for 70% of total clearance, with 51% renally excreted as unchanged drug.
Category C
Category C
SGLT2 Inhibitor / Biguanide Combination
SGLT2 Inhibitor