Type 2 Diabetes: Risk for bone fracture and decreased bone mineral density under canagliflozin therapy

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 September 12, 2015 – Drug Safety Information: The American Food and Drug Administration (FDA)  has just strengthened the warning for the type 2 diabetes medicines containing  canagliflozin as active ingredient, i.e. Invokana and Invokamet, related to the increased risk of bone fractures, and added new information about decreased bone mineral density in afflicted patients. To address these safety concerns, FDA added a new WARNING AND PRECAUTION and revised the ADVERSE REACTIONS section of the Invokana and Invokamet drug labels.

Canagliflozin containing medicines such as Invokana and Invokamet are  prescription medicines used with diet and exercise to lower blood sugar in adults with type 2 diabetes. They belong to a class of drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors. Canagliflozin is available as a single-ingredient product under the brand name Invokana and also in combination with the diabetes medicine metformin under the brand name Invokamet. Bone mineral density relates to the strength of a person’s bones. FDA is ontinuing to evaluate the risk of bone fractures with other drugs in the SGLT2 inhibitor class, including Farxiga and Xigduo XR, which both contain dapagliflozin as active ingredient, and Jardiance, Glyxambi, and Synjardy, all of which contain empaglifozin as active ingredient, in order to determine if additional label changes or studies are needed. Health care professionals and patients are urged to report side effects involving canagliflozin or other SGLT2 inhibitors to the FDA MedWatch program.

Recommendations: Health care professionals should consider factors that contribute to fracture risk prior to starting patients on canagliflozin. Patients should talk to their health care professionals about factors that may increase their risk for bone fracture. Patients should not stop or change their diabetes medicines without first talking to their health care professional.

Additional information for Health Care Professionals:

  • Bone fractures have been seen in patients taking the type 2 diabetes medicine canagliflozin.
  • Fractures can occur as early as 12 weeks after starting canagliflozin.
  • Canagliflozin has also been linked to decreases in bone mineral density at the hip and lower spine.
  • Consider factors that contribute to fracture risk prior to initiating canagliflozin.
  • Counsel patients about factors that may contribute to bone fracture risk.

Additional information for Patients:

Do not stop or change your diabetes medicines without first talking to your health care professional. When untreated, diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

  • Complete and submit the report Online: www.fda.gov/MedWatch/report
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.

 

Additional Comment:

The author of this post would like to remind readers that the SGLT2-inhibitors discussed here have earlier already been associated with ketoacidosis also. Moreover, some of the medicines discussed here (i.e., Xigduo XR and Synjardy) come with a BOXED WARNING for lactic acidosis as well. This later adverse affect might mainly be due to the presence of metformin in these medicines since lactic acidosis is frequently associated with metformin exposure, be it as single active ingredient in medicines or as part of a combination, just as in Xigdou XR or Synjardy.

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About the Author
thassodotcom Ph.D.; Professor in Pharmacology and Toxicology. Senior expert in theragenomic and personalized medicine and individualized drug safety. Senior expert in pharmaco- and toxicogenetics. Senior expert in human safety of drugs, chemicals, environmental pollutants, and dietary ingredients.

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