Invokana vs. Trulicity

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

Key Takeaways

  • Invokana is a once-daily pill that lowers blood sugar through the kidneys, while Trulicity is a once-weekly injection that works through the GLP-1 pathway.

  • Both drugs can lower cardiovascular risk, but Trulicity's approval covers a broader group, including people with multiple risk factors rather than only existing heart disease.

  • Invokana's most common side effects are genital and urinary infections, while Trulicity's are gastrointestinal, so personal risk tolerance often guides the choice.

Invokana vs. Trulicity Drug Summary

Invokana

Invokana (canagliflozin) is an SGLT2 inhibitor that treats type 2 diabetes by causing the kidneys to remove excess sugar through urine. It comes as a once-daily tablet taken before the first meal, and it also carries approvals for reducing cardiovascular risk and slowing kidney disease progression in people with diabetic nephropathy.

Trulicity

Trulicity (dulaglutide) is a GLP-1 receptor agonist that treats type 2 diabetes by helping the body release insulin and slow digestion after meals. It is given as a once-weekly injection with a prefilled pen, and it is also approved to lower cardiovascular risk in adults with existing heart disease or multiple risk factors.

Invokana vs. Trulicity 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%)

Trulicity

Most common
nausea (up to 21.1%)
diarrhea (up to 13%)
vomiting (up to 13%)
abdominal pain (up to 13%)

Invokana vs. Trulicity 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

Trulicity

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.75 mg once weekly Weeks 1-4
Maximum dose 1.5 mg once weekly Week 5 onward
Dose changes 1 increase Every 4 weeks

Invokana vs. Trulicity Indications

Invokana

Invokana is FDA-approved to improve blood sugar control in adults and children 10 and older with type 2 diabetes, alongside diet and exercise. It also carries approvals to reduce the risk of major cardiovascular events in adults with established heart disease, and to slow kidney disease progression in adults with diabetic nephropathy and significant protein in the urine.

  • Blood sugar control in adults and children 10+ with type 2 diabetes

  • Reduce risk of heart attack, stroke, or CV death with existing heart disease

  • Slow kidney disease progression in diabetic nephropathy with albuminuria

  • Not recommended for type 1 diabetes or with eGFR under 30

Trulicity

Trulicity is FDA-approved to improve blood sugar control in adults and children 10 and older with type 2 diabetes. It is also approved to reduce the risk of major cardiovascular events in adults with type 2 diabetes who have existing heart disease or multiple cardiovascular risk factors. Some clinicians prescribe it off-label for weight loss in people without diabetes.

  • Blood sugar control in adults and children 10+ with type 2 diabetes

  • Reduce risk of heart attack, stroke, or CV death in a broader risk group

  • Off-label: weight loss in people without diabetes

  • Not approved for type 1 diabetes or diabetic ketoacidosis

Invokana vs. Trulicity Pros and Cons

Invokana

Invokana works through the kidneys rather than the gut, so it tends to avoid the nausea and vomiting common with GLP-1 injections, and it comes as a once-daily pill that fits easily into a routine. Its list price is generally lower than Trulicity's, though actual out-of-pocket cost still depends on insurance coverage.

Pros

  • Oral tablet, no needles or injection training required

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

  • Added label support for slowing kidney disease progression in diabetic nephropathy

Cons

  • Common genital yeast infections and urinary tract infections

  • Not recommended once eGFR falls below 30

  • Carries a warning about lower limb infections and possible amputation

  • Tends to produce less weight loss than GLP-1 injections like Trulicity

Trulicity

Trulicity works through the GLP-1 pathway, which tends to produce more weight loss than SGLT2 inhibitors but comes with a higher rate of nausea and digestive side effects, especially while the dose is increasing. Its once-weekly injection may appeal to people who prefer fewer doses, though it costs more out of pocket than Invokana.

Pros

  • Once-weekly injection means fewer doses to remember

  • Tends to produce more weight loss than SGLT2 inhibitors

  • Cardiovascular risk reduction covers a broader group, including multiple risk factors alone

Cons

  • Roughly $987 to $1,065 per month without insurance, before savings programs

  • Common nausea, vomiting, and diarrhea, especially early on

  • Boxed warning for thyroid C-cell tumors seen in animal studies

  • Contraindicated with personal or family history of medullary thyroid cancer or MEN2

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