Invokana vs. Amaryl

See how Invokana and Amaryl compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Invokana is an SGLT2 inhibitor that also lowers cardiovascular and kidney risk, while Amaryl is a sulfonylurea that only targets blood sugar.

  • Amaryl carries a much higher risk of hypoglycemia than Invokana, which rarely causes low blood sugar on its own.

  • Amaryl is available as a low-cost generic, while Invokana costs significantly more even before insurance.

Invokana vs. Amaryl Drug Summary

Invokana

Invokana (canagliflozin) is an SGLT2 inhibitor for type 2 diabetes, taken as a once-daily tablet before the first meal of the day. Beyond lowering blood sugar, it is also approved to reduce cardiovascular death, heart attack, and stroke risk in people with existing heart disease, and to slow kidney damage in people with diabetic kidney disease.

Amaryl

Amaryl (glimepiride) is a sulfonylurea for type 2 diabetes, taken as a once-daily tablet, usually with breakfast. It works by prompting the pancreas to release more insulin and is approved only to improve blood sugar control, without any added heart or kidney benefit.

Invokana vs. Amaryl Side Effects

Invokana

Most common
Genital yeast infection (up to 11%)
Urinary tract infection (up to 6%)
Increased urination (up to 5%)
Male genital yeast infection (up to 4%)

Amaryl

Most common
Hypoglycemia (up to 19.7%)
Accidental injury (up to 16%)
Dizziness (up to 5%)
Headache (up to 5%)

Invokana vs. Amaryl Dosage

Invokana

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 100 mg once daily At the start
Maximum dose 100 mg once daily Same as starting
Dose changes None Fixed dose

Amaryl

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 mg or 2 mg once daily At the start
Maximum dose 8 mg once daily If needed
Dose changes 2 increases As tolerated

Invokana vs. Amaryl Indications

Invokana

Invokana is approved to improve blood sugar control in adults with type 2 diabetes as an add-on to diet and exercise. It also carries added approvals to reduce the risk of major cardiovascular events in people with existing heart disease, and to slow kidney damage and reduce heart failure hospitalizations in people with diabetic kidney disease and protein in the urine.

  • Adjunct to diet and exercise for type 2 diabetes

  • Reduces cardiovascular death, heart attack, and stroke risk in adults with established heart disease

  • Slows kidney disease progression and reduces heart failure hospitalization in diabetic nephropathy

  • Not approved for type 1 diabetes or diabetic ketoacidosis

Amaryl

Amaryl is approved to improve blood sugar control in adults with type 2 diabetes as an add-on to diet and exercise. Unlike some newer diabetes drugs, it carries no additional approval for heart or kidney protection, and its use is limited to glycemic control alone.

  • Adjunct to diet and exercise for type 2 diabetes

  • Only sulfonylurea FDA-approved for combination therapy with insulin

  • Not approved for type 1 diabetes or diabetic ketoacidosis

  • No added cardiovascular or kidney protection indication

Invokana vs. Amaryl Pros and Cons

Invokana

Invokana offers proven heart and kidney protection beyond blood sugar control, which sets it apart from older diabetes pills. It carries a boxed warning for lower limb amputation and a real risk of genital infections, and its brand-only pricing runs well above a generic sulfonylurea.

Pros

  • Reduces cardiovascular death, heart attack, and stroke risk in patients with heart disease

  • Slows kidney disease progression and reduces heart failure hospitalization risk

  • Low risk of causing hypoglycemia when used on its own

  • Simple once-daily tablet with only two dose strengths

Cons

  • Boxed warning for lower limb amputation risk

  • Can cause genital yeast infections and urinary tract infections

  • Risk of diabetic ketoacidosis and dehydration

  • Roughly $550 to $830 per month without insurance, before savings programs

Amaryl

Amaryl is a well-established, inexpensive option for lowering blood sugar, but it does not offer the heart or kidney benefits seen with newer drug classes. Its main tradeoff is a meaningfully higher risk of hypoglycemia and no proven long-term cardiovascular protection.

Pros

  • Available as a low-cost generic at most pharmacies

  • Decades of clinical use since its 1995 approval

  • Only sulfonylurea approved for combination with insulin

  • Roughly $15 to $110 per month without insurance, before savings programs

Cons

  • Higher risk of hypoglycemia, especially with skipped meals

  • Carries a warning about possible increased cardiovascular mortality risk from older sulfonylurea studies

  • No proven cardiovascular or kidney protective benefit

  • Blood sugar control may weaken over time as insulin-producing capacity declines

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