august 2015 clinical advisor
DESCRIPTION
The Clinical Advisor is a monthly journal for nurse practitioners and physician assistants in primary care. Its mission is to keep practitioners up to date with the latest information about diagnosing, treating, managing, and preventing conditions seen in a typical office-based primary-care setting.TRANSCRIPT
SAFETY675rdquoSAFETY95rdquo
TRIM775rdquoTRIM
105rdquo
BLEED875rdquoBLEED115rdquo
LARGE TRIM85rdquoLARGE TRIM
11rdquo
THIS ADVERTISEMENT PREPARED BY NeONClient JampJProduct INVOKANA Job 10304019Job Name A-Size Ad Code 033360-150417
PublicationsColors 4CSizes Bleed 875 W x 115 H
Trim 775 W x 105 H Live 675 W x 95 H
12 Page Trim 325rdquo W x 95rdquo H
10304019 Creative evolution ads a-siZe
INSPIRE PATIENTS TOGO FURTHER
In the treatment of type 2 diabetes help
IMPORTANT SAFETY INFORMATION (contrsquod)WARNINGS and PRECAUTIONSgtgt Hypotension INVOKANAreg causes intravascular volume contraction Symptomatic hypotension
can occur after initiating INVOKANAreg particularly in patients with impaired renal function (eGFR lt60 mLmin173 m2) elderly patients patients on either diuretics or medications that interfere with the renin-angiotensin-aldosterone system or patients with low systolic blood pressure Before initiating in patients with ge1 of these characteristics volume status should be assessed and corrected Monitor for signs and symptoms after initiating
gtgt Impairment in Renal Function INVOKANAreg increases serum creatinine and decreases eGFR Patients with hypovolemia may be more susceptible to these changes Renal function abnormalities can occur after initiation More frequent renal function monitoring is recommended in patients with an eGFR lt60 mLmin173 m2
INVOKANAreg (canagliflozin) starting dose 100 mg once daily In patients tolerating the starting dose who have an eGFR ge60 mLmin173 m2 and require additional glycemic control the dose can be increased to 300 mg once daily2
033360-150417_INVOKANA_Journal_ad_A_FR2indd 2 61015 112 PM
SAFETY675rdquoSAFETY95rdquo
TRIM775rdquoTRIM
105rdquo
BLEED875rdquoBLEED115rdquo
LARGE TRIM85rdquoLARGE TRIM
11rdquo
THIS ADVERTISEMENT PREPARED BY NeONClient JampJProduct INVOKANAJob 10304019Job Name A-SizeAd Code 033360-150417
PublicationsColors 4CSizes Bleed 875 W x 115 H
Trim 775 W x 105 HLive 675 W x 95 H
12 Page Trim 325rdquo W x 95rdquo H
10304019 Creative evolution ads a-siZe
INVOKANAreg 300 mg + metformin and a sulfonylurea (n=377)
Januviareg (sitagliptin) 100 mg + metformin and a sulfonylurea (n=378)
ndash066ndash103
813 812Mean baseline
95 CI ndash050 ndash025 P005
Adjusted Mean Change in A1C From Baseline ()
ndash037difference
GREATER REDUCTIONS in body weight2daggerDiff erence from Januviareg 100 mg ndash28 Plt0001
Incidence of hypoglycemia2
INVOKANAreg 300 mg 432 Januviareg 100 mg 407 The incidence of hypoglycemia increases when used in combination with insulin or an insulin secretagogue
GREATER REDUCTIONS in systolic blood pressure3daggerDiff erence from Januviareg 100 mg ndash59 mm Hg Plt0001
Adverse events (AEs)3
Incidences of AEs were similar between groups except for
Malefemale genital mycotic infection INVOKANAreg 300 mg 92153 Januviareg 100 mg 0543 Increased urine frequencyvolume INVOKANAreg 300 mg 1608 Januviareg 100 mg 130
Learn more and register for updates at
INVOKANAhcpcomA randomized double-blind active-controlled 52-week study of patients with type 2 diabetes inadequately controlledon maximally or near-maximally eff ective doses of metformin (ge2000 mgday or ge1500 mgday if higher dose not tolerated)and a sulfonylurea3
INVOKANAreg is not indicated for weight loss or as an antihypertensive treatment daggerAdjusted mean change from baseline
Indicated trademarks are registered trademarks of their respective owners
Secondary endpoint Secondary endpoint
INVOKANAreg 300 mg demonstrated greater reductions in A1C vs Januviareg 100 mg
at 52 weeks in patients inadequately controlled on metformin + a sulfonylurea2
GREATER REDUCTIONS in A1C2
gtgt Hyperkalemia INVOKANAreg can lead to hyperkalemia Patients with moderate renal impairment who are taking medications that interfere with potassium excretion or medications that interfere with the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia Monitor serum potassium levels periodically in patients with impaired renal function and in patients predisposed to hyperkalemia due to medications or other medical conditions
gtgt Hypoglycemia With Concomitant Use With Insulin and Insulin Secretagogues INVOKANAreg can increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue A lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with INVOKANAreg
gtgt Genital Mycotic Infections INVOKANAreg increases risk of genital mycotic infections Patients with history of these infections and uncircumcised males were more likely to develop these infections Monitor and treat appropriately
gtgt Hypersensitivity Reactions Hypersensitivity reactions (eg generalized urticaria) some serious were reported with INVOKANAreg these reactions generally occurred within hours to days after initiation If reactions occur discontinue INVOKANAreg treat per standard of care and monitor until signs and symptoms resolve
Please see additional Important Safety Information and briefsummary of full Prescribing Information on the following pages
033360-150417_INVOKANA_Journal_ad_A_FR2indd 3 61015 112 PM
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-
SAFETY675rdquoSAFETY95rdquo
TRIM775rdquoTRIM
105rdquo
BLEED875rdquoBLEED115rdquo
LARGE TRIM85rdquoLARGE TRIM
11rdquo
THIS ADVERTISEMENT PREPARED BY NeONClient JampJProduct INVOKANAJob 10304019Job Name A-SizeAd Code 033360-150417
PublicationsColors 4CSizes Bleed 875 W x 115 H
Trim 775 W x 105 HLive 675 W x 95 H
12 Page Trim 325rdquo W x 95rdquo H
10304019 Creative evolution ads a-siZe
INVOKANAreg 300 mg + metformin and a sulfonylurea (n=377)
Januviareg (sitagliptin) 100 mg + metformin and a sulfonylurea (n=378)
ndash066ndash103
813 812Mean baseline
95 CI ndash050 ndash025 P005
Adjusted Mean Change in A1C From Baseline ()
ndash037difference
GREATER REDUCTIONS in body weight2daggerDiff erence from Januviareg 100 mg ndash28 Plt0001
Incidence of hypoglycemia2
INVOKANAreg 300 mg 432 Januviareg 100 mg 407 The incidence of hypoglycemia increases when used in combination with insulin or an insulin secretagogue
GREATER REDUCTIONS in systolic blood pressure3daggerDiff erence from Januviareg 100 mg ndash59 mm Hg Plt0001
Adverse events (AEs)3
Incidences of AEs were similar between groups except for
Malefemale genital mycotic infection INVOKANAreg 300 mg 92153 Januviareg 100 mg 0543 Increased urine frequencyvolume INVOKANAreg 300 mg 1608 Januviareg 100 mg 130
Learn more and register for updates at
INVOKANAhcpcomA randomized double-blind active-controlled 52-week study of patients with type 2 diabetes inadequately controlledon maximally or near-maximally eff ective doses of metformin (ge2000 mgday or ge1500 mgday if higher dose not tolerated)and a sulfonylurea3
INVOKANAreg is not indicated for weight loss or as an antihypertensive treatment daggerAdjusted mean change from baseline
Indicated trademarks are registered trademarks of their respective owners
Secondary endpoint Secondary endpoint
INVOKANAreg 300 mg demonstrated greater reductions in A1C vs Januviareg 100 mg
at 52 weeks in patients inadequately controlled on metformin + a sulfonylurea2
GREATER REDUCTIONS in A1C2
gtgt Hyperkalemia INVOKANAreg can lead to hyperkalemia Patients with moderate renal impairment who are taking medications that interfere with potassium excretion or medications that interfere with the renin-angiotensin-aldosterone system are more likely to develop hyperkalemia Monitor serum potassium levels periodically in patients with impaired renal function and in patients predisposed to hyperkalemia due to medications or other medical conditions
gtgt Hypoglycemia With Concomitant Use With Insulin and Insulin Secretagogues INVOKANAreg can increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue A lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with INVOKANAreg
gtgt Genital Mycotic Infections INVOKANAreg increases risk of genital mycotic infections Patients with history of these infections and uncircumcised males were more likely to develop these infections Monitor and treat appropriately
gtgt Hypersensitivity Reactions Hypersensitivity reactions (eg generalized urticaria) some serious were reported with INVOKANAreg these reactions generally occurred within hours to days after initiation If reactions occur discontinue INVOKANAreg treat per standard of care and monitor until signs and symptoms resolve
Please see additional Important Safety Information and briefsummary of full Prescribing Information on the following pages
033360-150417_INVOKANA_Journal_ad_A_FR2indd 3 61015 112 PM
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