December 16, 2015 22:00 ET

Dr. Gregory Brammer -- Brings Awareness to the New Diabetes Drug INVOKANA

NEW YORK, NY--(Marketwired - December 16, 2015) - Expert Emergency Medicine Specialist and Fellow of the American College of Emergency Physicians, Dr. Gregory Brammer has recently brought awareness to the potential dangers of the new diabetes drug INVOKANA (canagliflozin). As one of the newest drug options, INVOKANA has been highly lauded for the treatment of Type II Diabetes, but after being used by a large population of patients, has not proven to be as safe as initially thought.

According to Dr. Brammer, INVOKANA is recommended as an adjunct to exercise and diet to stabilize and decrease blood sugar levels and is the most popular of the new class of medications for Type II Diabetes called Gliflozins. The Kidney is the organ targeted by Gliflozins. With the average body containing about 5 L of blood, the kidneys are tasked with filtering approximately 150-180 L of blood daily resulting in the elimination of an average urine output of 1-2 L. This means that we reabsorb approximately 99% of what is filtered including glucose, except in the case of INVOKANA which partially blocks the reabsorption of glucose through the inhibition of the SGLT2 receptor (the sodium-glucose-cotransporter). 

In his effort to explain why INVOKANA may lead to the single most catastrophic acute diabetic event, Diabetic Ketoacidosis (DKA), Dr. Brammer differentiated between the two primary physiological systems that determine the acidity (pH) of our blood -- the pulmonary system (lungs) and the genitourinary system (kidneys). When the blood becomes too acidic, we blow off carbon dioxide when we breathe deeper and/or faster, while the kidneys adjust the amount of bicarbonate that is re-absorbed to neutralize the blood's pH.

In May 2015, the FDA sent a safety announcement to all healthcare providers warning that SGLT2 inhibitors (such as INVOKANA or any mixture of oral medication that contains INVOKANA) may lead to DKA. Dr. Brammer explains, "The single most poignant issue is that in Gliflozin induced Type II DKA, the blood glucose level is only fractionally elevated (as low as 200) compared to classical Type II DKA in which levels are typically between 500-800. By strict definition, Type I DKA requires a minimum glucose level of 250. This represents a complete paradigm shift!" Dr. Brammer also lists the early symptoms of DKA including "dry mouth and thirst, frequent urination, nausea and vomiting, abdominal pain, confusion, fruity odor on the breath from ketones".

Dr. Gregory Brammer also points to additional potentially deleterious side effects of Gliflozins such as INVOKANA, "It is well established that INVOKANA almost invariably results in renal impairment, which can result in renal failure, thus necessitating treatment with dialysis and possible kidney transplantation. Additionally, coma or alteration of mental status may result from DKA or from renal failure itself. It is also known that potassium can be elevated from INVOKANA use. Severe potassium elevations may result in heart dysrhythmias such as ventricular tachycardia or ventricular fibrillation that can cause heart attacks."

The most recent warning issued by the FDA in September 2015 regarding INVOKANA use involves its ability to significantly reduce bone density at 12 weeks. Dr. Brammer sees this side effect of the drug as an additional safety concern especially in the elderly, "INVOKANA's proclivity to cause low blood pressure (hypotensive) events, may lead to the perfect storm in which an elderly patient falls from a hypotensive event and then fractures a bone (most commonly the hip) from the known decrease in bone density. Hip fractures, unfortunately, may be a terminal event, carrying a one-year mortality of 25%, and of those who survive the acute post-surgical hip repair, 70% will be placed into a nursing home." INVOKANA has also been shown to increase genital fungal infections in both males as well as females. There is also an increased incidence of urinary tract infections. 

Through his expertise in treating DKA and other diabetic events, Dr. Gregory Brammer urges his audience to avoid INVOKANA and instead continue with the safe and reliable diabetic medication Glucophage (Metformin). "It is the number one diabetic pill still prescribed, has a fairly similar efficacy as INVOKANA, and without insurance the generic form costs about $4 per month. Its side effect profile appears much safer than INVOKANA which will cost as much as $250-$400 dollars monthly without insurance."

Dr. Gregory Brammer has almost 20 years of experience as an expert Board Certified and Board Trained Emergency Medicine Physician. He is an international speaker and consultant, who has served an estimated 2.5 million people over his career. Due to his expertise as an EMS Specialist, Physician, Cardiac Resuscitation Expert and Educator, Dr. Brammer's works have been published in the Annals of Emergency Medicine and Veterinary & Human Toxicology. He has spoken and lectured internationally on the subjects of Point-of-Care-Testing, Emergency Medicine Services, and other topics related to health and medicine.

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