Invokana Linked to Higher Risk of Ketoacidosis

October 1, 2015 — The risk of diabetic ketoacidosis is much higher for patients on Invokana than other SGLT2 inhibitors, through the incidence was still low, according to a new editorial in Diabetes Care.

Invokana belongs to a new class of drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Dr. Julio Rosenstock and colleagues said doctors should be well-informed of the risk of diabetic ketoacidosis and be able to recognize patients who have risk-factors.

Earlier this year, the FDA issued a Safety Communication to warn about 20 reports of diabetic ketoacidosis in patients on SGLT2 inhibitors since Invokana hit the market in March 2013. Later that same month, the European Medicines Agency (EMA) said 101 cases had beed linked to SGLT2 inhibitors worldwide.

According to researchers, most of the cases involved patients who had illnesses, reduced food and fluid intake, a history of alcohol intake, and insulin users with reduced insulin intake.

Researchers provided data suggesting that less than 0.1% of patients on SGLT2 inhibitors develop diabetic ketoacidosis. However, the risk could be increased in patients who have risk-factors like beta-cell insufficiency, post-surgical patients, latent auto-immune diabetes, or patients who have had diabetes for many years.

Diabetic ketoacidosis occurs when there is too much acid in the bloodstream. It is life-threatening and usually must be treated with hospitalization. If the patient has only mild or moderate hyperglycemia, diagnosis may be delayed and the risk of complications increases.

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