Diabetes Home > Invokana Alternatives
People who are taking Invokana (canagliflozin) and experience bothersome side effects or whose blood sugar levels are not adequately controlled may benefit from other forms of diabetes treatment. Some of the alternatives to Invokana include lifestyle changes, other oral medications, and insulin. Your healthcare provider can help you compare these various options to find one that's best for you.
Invokana® (canagliflozin) is a prescription medication used for the treatment of type 2 diabetes. It belongs to a group of diabetes medications called sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors).
For many people, Invokana is effective in treating their diabetes, and most people tolerate it well. However, as with all medicines, side effects can occur or the medicine may not completely control a person's diabetes. Fortunately, there are several alternatives to Invokana. Many of these drugs can be used in addition to Invokana as well.
Some of these Invokana alternatives include:
Fortunately, there are many other types of oral drugs available to treat type 2 diabetes, including:
- Dipeptidyl peptidase inhibitors
- Alpha glucosidase inhibitors
- Ergot alkaloids
- A different sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)
- Bile acid sequestrants
- Combination medications.
Dipeptidyl Peptidase Inhibitors
This is a relatively new class of oral diabetes drugs. Currently, there are four medications available in the group: alogliptin (Nesina®), linagliptin (Tradjenta®), sitagliptin (Januvia®), and saxagliptin (Onglyza®). These drugs increase incretin levels in the body. Incretin is a hormone that helps to control blood sugar.
Sulfonylureas are medications that force the pancreas to make more insulin. Because of this, they are quite effective in controlling blood sugar but are also more likely to cause dangerously low blood sugar (hypoglycemia). These diabetes medications include:
- Chlorpropamide (Diabinese®)
- Glimepiride (Amaryl®)
- Glipizide (Glucotrol®, Glucotrol XL®)
- Glyburide (DiaBeta®, Micronase®, Glynase®)
- Tolazamide (Tolinase®)
- Tolbutamide (Orinase®).
Metformin (Fortamet®, Glucophage®, Glucophage XR®, Glumetza®, or Riomet®) is the only biguanide medication currently available. Metformin works by helping the body use its natural insulin better. It also decreases sugar (glucose) production by the liver, and decreases sugar absorption from the diet.
Meglitinides are similar to sulfonylureas, in that they force the pancreas to produce more insulin. However, they are short-acting and are less likely to cause dangerously low blood sugar. They are usually taken before every meal. Meglitinides include:
These medications work mostly by helping the body to use its natural insulin better. There are currently two thiazolidinediones available for type 2 diabetes treatment, including:
Alpha Glucosidase Inhibitors
These diabetes medications prevent the breakdown of sugar and carbohydrates in the digestive tract, slowing down their absorption. These medications are used to decrease blood sugar levels after meals. These medications include:
One ergot alkaloid, bromocriptine (Cycloset®), is approved for treating type 2 diabetes. Bromocriptine is actually an older medication that has been used for quite some time for other uses, although it was only recently approved for treating diabetes.
Bromocriptine works uniquely, compared to other diabetes medications. It works as a dopamine receptor agonist, which means that it binds to and stimulates dopamine receptors. It is thought that stimulating dopamine receptors in the brain at certain times of the day "resets" the biological clock and improves metabolism. It is thought that seasonal changes in the metabolism of wild animals are due to similar mechanisms.
A Different Sodium-Glucose Co-Transporter 2 Inhibitor (SGLT2 Inhibitor)
SGLT2 inhibitors work by causing glucose to be lost from the bloodstream into the urine. The other approved medications in this class are Farxiga™ (dapagliflozin) and Jardiance® (empagliflozin). These drugs tend to lower blood pressure and cause a small amount of weight loss, which can often be desirable effects in people with type 2 diabetes.
Bile Acid SequestrantsOften overlooked as a diabetes drug, Welchol® (colesevelam) is a bile acid sequestrant that was initially approved for treating high cholesterol but was later approved for treating type 2 diabetes. It helps to lower both blood sugar and cholesterol levels, which can be very useful in many people with diabetes. The downside is that the usual dosage involves taking six tablets a day. It can also bind with (and therefore interact with) some other drugs.
There are a variety of combination medications available, including:
- Alogliptin and metformin (Kazano®)
- Alogliptin and pioglitazone (Oseni®)
- Glipizide and metformin (Metaglip®)
- Glyburide and metformin (Glucovance®)
- Linagliptin and metformin (Jentadueto®)
- Pioglitazone and glimepiride (Duetact®)
- Pioglitazone and metformin (Actoplus Met®, Actoplus® Met XR)
- Repaglinide and metformin (PrandiMet®)
- Rosiglitazone and glimepiride (Avandaryl®)
- Rosiglitazone and metformin (Avandamet®)
- Saxagliptin and metformin (Kombiglyze™ XR)
- Sitagliptin and metformin (Janumet®)
- Sitagliptin and metformin XR (Janumet® XR)
- Sitagliptin and simvastatin (Juvisync®), which is no longer available.