[Posted 08/26/2020]

AUDIENCE: Patient, Health Professional, Endocrinology, Pharmacy

ISSUE: Based on FDA’s review of new data from three clinical trials, the boxed warning about amputation risk from the diabetes medicine canagliflozin (Invokana, Invokamet, Invokamet XR) was removed from the prescribing information. 

FDA reviews of new clinical trial data demonstrated additional heart- and kidney-related benefits, which led to additional approved uses.  Specifically, in 2018, canagliflozin was approved to reduce the risk of major heart-related events such as heart attack, stroke, or death in patients with type 2 diabetes who have known heart disease; and, in 2019, it was approved to reduce the risk of end-stage kidney disease, worsening of kidney function, heart-related death, and being hospitalized for heart failure in certain patients with type 2 diabetes and diabetic kidney disease.  

Collectively, these newly identified effects of canagliflozin on heart and kidney disease show significantly enhanced benefit of this medicine.  Safety information from recent clinical trials also suggests that the risk of amputation, while still increased with canagliflozin, is lower than previously described, particularly when appropriately monitored.  Based upon these considerations, FDA has concluded that the boxed warning should be removed.  

BACKGROUND: Today’s information is an update to the FDA Drug Safety Communication: FDA confirms increased risk of leg and foot amputations with the diabetes medicine canagliflozin (Invokana, Invokamet, Invokamet XR) issued on May 16, 2017.

Canagliflozin belongs to a class of medicines called sodium-glucose cotransporter-2 (SGLT2) inhibitors.  It lowers blood sugar by causing the kidneys to remove sugar from the body through the urine.  
RECOMMENDATION: Health care professionals and patients should continue to recognize the importance of preventative foot care and monitor for new pain, tenderness, sores, ulcers, and infections in the legs and feet.  Risk factors that may predispose patients to the need for amputation should be considered when choosing antidiabetic medicines.

Patients and health care professionals 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.
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178.

[08/26/2020 – Drug Safety Communication – FDA] 
[05/16/2017 – Drug Safety Communication – FDA]