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
Amaryl
Invokana vs. Amaryl Dosage
Invokana
Amaryl
| 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 |
| 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
| 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
| 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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