Incruse elipta?

Incruse Eplitra is the brand name for the inhaled form of canagliflozin (the same active ingredient that’s sold orally as Invokana®). It was approved by the FDA in 2019 for the treatment of adults with type‑2 diabetes mellitus (T2DM) who need an additional glucose‑lowering medication on top of diet, exercise and other glucose‑lowering agents.

Below is a quick‑reference guide – if you’re considering it for yourself or a patient, talk to a healthcare provider for personalized advice.

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1. What it does (mechanism)

• Canagliflozin is an SGLT‑2 (sodium‑glucose cotransporter‑2) inhibitor.
• SGLT‑2 transports glucose from the blood back into the kidney tubules.
• Inhibiting it reduces glucose reabsorption → more glucose is excreted in the urine → lower blood glucose levels.
• In the inhaled formulation, the drug is delivered directly into the lungs and acts locally, but its systemic absorption still leads to the same SGLT‑2 effect.

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2. Approved Uses

• Type‑2 diabetes: add‑on therapy to diet and exercise and/or other glucose‑lowering drugs (e.g., metformin, sulfonylureas).
• Not approved for:
  • Type‑1 diabetes
  • Diabetic ketoacidosis (DKA) prevention or treatment
  • Weight loss or obesity

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3. How it’s taken

Dose	Frequency	Notes
200 mg	Once daily (at any time of day)	Inhaled using the Incruse Eplitra inhaler (hand‑held).

• Start‑up: 200 mg daily; no dose‑up schedule (no higher dose).
• Missed dose: Skip and resume the next scheduled dose; do not double‑dose.
• Storage: Store at 2–30 °C (room temp). Keep the inhaler cap closed when not in use. Do not refrigerate.

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4. Who’s it for?

• Adults ≥18 y with T2DM
• eGFR ≥45 mL/min/1.73 m² (not for severe kidney impairment)
• Not recommended for patients with a history of:
  • Diabetic ketoacidosis
  • Severe hepatic impairment
  • Uncontrolled infections in the lungs
  • Pregnant or lactating women (no data)

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5. What to watch for

Common Side Effects

Symptom	Frequency
Cough, sore throat	1–2 %
Nasal congestion	1 %
Upper respiratory infection	1 %
Decreased appetite	<1 %

Serious/Important

Issue	How to manage	When to seek help
Ketoacidosis (rare, but serious)	Check for fruity breath, nausea, abdominal pain	Call 911 or go to ER
Hypoglycemia (especially if on insulin or sulfonylurea)	Monitor blood glucose, have quick carbs	Severe symptoms
Renal impairment	Check eGFR before starting; re‑check every 3–6 mo	Rapid decline
Bone fractures	Higher risk reported with oral canagliflozin	Seek care if fractures occur

Drug Interactions

• Other SGLT‑2 inhibitors: Not recommended to combine.
• Insulin / Sulfonylureas: ↑ hypoglycemia risk.
• Diuretics (especially loop): ↑ risk of dehydration/renal injury.
• ACE inhibitors / ARBs: monitor kidney function.

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6. Lifestyle & Monitoring

• Blood glucose: Check daily; adjust other meds as needed.
• eGFR: Baseline and then every 3–6 months.
• Weight & BP: Monitor for changes (SGLT‑2s can cause modest weight loss & BP drop).
• Urine: Watch for infections, especially genital.
• Vaccinations: Influenza & COVID‑19 (especially important for respiratory drugs).

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7. Availability

• Market status: In 2023 Pfizer withdrew the drug from U.S. sale because of low demand and high competition from oral SGLT‑2 inhibitors. It may still be available in other countries or through special‑access programs.
• Cost: When available, it was typically $350–$400/month (price varies).

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8. Bottom Line

• Pros: One‑day inhalation, no need for oral dosing, potentially convenient for patients who dislike pills.
• Cons: Limited data compared with oral SGLT‑2 drugs, higher cost, possible respiratory side effects, market withdrawal in the U.S.

If you’re exploring options for type‑2 diabetes control, discuss with your provider whether an inhaled SGLT‑2 inhibitor fits your needs, or if an oral agent would be simpler and more cost‑effective.

Disclaimer: This summary is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.