Invokana side effects - how common are they?


Jennifer Murphy
 

I'm beginning to regret sticking with the Metformin and not switching to Invokana a few months ago.  Flea's insulin was down but still too high, so we opted to keep going with the Metformin.  I had radiographs done at his trim shortly after that so we could be sure we were on the right path to correct any issues.  Since that time, I've kept track of when Flea is footsore, and I'm seeing a pattern of about 8-10 days of good, then 5-7 days of being footsore.  Right now, he can barely lift his feet and is what I refer to as being essentially crippled.  I tried putting him in cloud pads, but he's even worse now.  (He's been in boots 24/7 for nearly 2 years now.)

I emailed my vet to ask if we could pull blood, look at his numbers, and possibly put him on the Invokana.  She was willing to this a few months ago and even ran a CBC panel, but now she isn't on board.  The expense, potential side effects, and not knowing if it will actually help or not are her concerns. 

So my question is, just how often does Invokana fail?  How prevalent are side effects?  Does his being a mule raise any concerns that might not be addressed with a horse?

As far as his seemingly cyclical soreness, is it possible it's not related to insulin, but something else?  Maybe something that could be addressed by a chiropractic adjustment?
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Eleanor Kellon, VMD
 

There have been no side effects.There is increased urine production in some horses but that is to be expected and not a side effect.  In terms of eliminating pain, there have been no failures. All horses had insulin tests drop to normal or near normal except one but that horse also had laminitis resolve, fat deposits reduce or disappear.

I have the draft of an article I can send her.

 How does the soreness relate to time of trims?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jennifer Murphy
 

That is so good to know. 
She has the information you sent her before, but she's just reluctant to get on board.

Flea is always much better after a trim, then tends to get sore a week or so later.  My trimmer asked me the same thing, thinking it was the trim that was doing it, but it's the opposite.  We shortened his trim cycles to every 3 weeks from 5 to try to keep ahead of the issue, but he still fluctuates between trims, usually toward the end of the cycle just before his next trim.
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Jennifer Murphy
 

I just added the radiographs from his October trim.  The vet did xrays before the trim, during the trim, and post trim so we could see the difference.  She wants the heels lower but the farrier believes Flea has contracted tendons, and doesn't want to lower them too much at once.
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Eleanor Kellon, VMD
 

 Agree with lowering the heels. The toe also needs a bevel to bring the breakover back.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

This is probably from traction on the laminae as the toe grows out. The bevel would fix that. Lowering the heels would also decrease pressure on the rim of the coffin bone. If he doesn't want to weight his heels you can use a  pad with heel elevation inside boots, lowering the degree of elevation gradually.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


TERRI JENNINGS
 

We’ve had no side effects. Finn was in his boots 24/7 and no longer needed his boots after a few days on Invokana. I presented it to my vet as a last resort. I wasn’t going to keep putting Finn or Elliott thru this. A few months of feeling ok between longer periods of time in pain from laminitis was no way to live. I also told her I would sign anything she wanted to absolve her of being liable for the outcome. I took full responsibility.  Invokana means they get a chance at a long life.  If your vet wants to talk to my vet I’m sure we could arrange it. She’s thrilled about our outcome. 
--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Jennifer Murphy
 

Terri, I just may take you up on that! 
One thing that confuses me is the urine testing - how do you do that, and how often is it needed? 

Dr. Kellon, thank you so much for your input.  I'll forward that on to my vet and farrier.
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Nancy Kitchen
 

Jennifer - just a member here but I wanted to add that my horse would not be with me now if not for the Invokana.  He still wears boots but otherwise he is sound, much happier and free from pain.  I had tried emergency diet, soaking hay, all the supplements that claim to help IR, and Metformin.  My vet has been on board with Invokana from the beginning as he has been with us thru the entire 1 1/2 yr struggle. My horse's insulin is now within the normal range but i still maintain his IR diet according to the protocol here.  He does urinate more as Dr Kellon stated but he has had no ill side effects from the med.  I check his urine about once a month now and that has been normal.  My vet did a urinalysis for me just to be on the safe side and all was fine.

I cannot say enough good things about this group and Dr Kellon.  Everyone is helpful and so knowledgeable and it's all free information.  All the best with your horse, hoping it all works out for you and Flea
--
Nancy K
Smoke and Tucky
November 2018, Southeast, MA

Smoke Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Smoke
Smoke Photo Album:    https://ecir.groups.io/g/CaseHistory/album?id=94122
Tucky Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Tuck 
Tucky Photo Album:


TERRI JENNINGS
 

We urine test every other week. I carry a round Tupperware type cup with a screw on lid. Finn has his favorite trail where he likes to urinate, Elliott always goes right on top of wherever Finn urinated. I had to get regular urine samples from one of my non-IR horses when he was in a clinical trial for headshaking/trigeminal neuralgia treatment. He almost always urinates a few minutes after he goes in the trailer after a ride. It worked every time I needed a sample. Knowing where and when your horse urinates is helpful. 

mince you have a sample just follow the directions for the dipsticks. 
--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


LJ Friedman
 

Jennifer., you mentioned your vet is not on board. When I started invokana I was able to get it with no prescription from Mexico and when my vet saw how well it was doing he was on board and gave me a prescription. If you  email me etc , I can offer suggestions (
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Jennifer Murphy
 

LJ, thank you!  I'm copying these responses and sending them to my vet to hopefully convince her it's the way to go. 

Nancy, thank you for your input - I've been struggling to get this under control on and off for about 4 years, and the last 2 years have been just awful.  I agree, this group is fantastic!

Terri, I'm glad you posted that about the urine sample, because I was wondering how often you're supposed to check.  I have no idea how I'll be able to get a sample because neither mule will allow me to approach them when they're doing that - for the most part they wait until I'm either far enough away or out of their area completely before putting themselves in a "vulnerable" position.  They sure don't make things easy, but I'll figure something out.  Maybe with the more frequent urination, I'll have better luck.

--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Alicia Harlov
 

Hi Nancy! 

Which vet has been really on board with Invokana in MA? Maybe I can have them chat with my vets. 
--
-Alicia Harlov in South Hamilton, MA 
PHCP hoofcare provider, The Humble Hoof podcast


riggslippert@...
 

Hi Jennifer,

I hope you are making progress on getting your horse on Invokana.  My horse has improved significantly since being started in mid October.  I board him and he has become very picky with his meals, so I knew there was no way metformin would be a viable option.  As far as obtaining urine samples, I found this on Amazon and it has been very helpful to obtain a sample from a distance and without getting hands wet :)

https://www.amazon.com/Cabachoc-Ill-Catch-U-Urine-Collection-Horses/dp/B07SGPN9QJ/ref=sr_1_18?crid=BEM6H9LYKSOI&dchild=1&keywords=urine+catcher+for+dogs&qid=1608548291&sprefix=urine+cat%2Caps%2C185&sr=8-18

Good luck!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




Jennifer Murphy
 

Oh my gosh, that is perfect (and I admit I had to laugh, because who comes up with this stuff?)! 

So for the last 12 days Flea has been very, very crippled up; it's awful to see.  He's been eating his mash for the most part, so he's getting probably 80-90% of his metformin into him daily.  I believe this isn't an insulin spike, but severe cold induced pain/winter laminitis.  He's in cotton socks well powdered, wool blend socks, Equine Fusion boots with dampening pads, and shearling lined "leggings".  He's getting jiaogulan 2x daily with his minerals/meds/supplements.  I have a heat lamp in his stall, but I don't lock him in as historically he's always been better if he can move around. I know it's been asked before, but I've never seen a real answer to this question - do equines on Invokana still succumb to the effects of winter laminitis?  If I put him on Invokana and he still has these episodes, I'm afraid I won't recognize if the medication is working or not. 

--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Eleanor Kellon, VMD
 

Metformin is clearly not working. Even if the cold is playing a role, keeping him warm won't counteract insulin that high. Is he still on Tylenol? Anything else for pain?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy Kitchen
 

Hi Alicia
I have permission from my vet to post his name and he is in the ECIR vet list - Bart Harrison works out of Middleboro Animal Clinic in Middleboro MA.  He's been so great to work with, always open to any conversation regarding laminitis and treatments.  I'm sure he would be happy to speak with your vet regarding the Invokana and any other treatments.  My horse has had no ill effects from the Invokana and I can say it literally saved his life.  He has been with me almost three years and this is the first winter that I have not had to blanket him or wrap his legs and feet.  He is able to maintain his own body temp this year... he's on 300 mg Invokana and 1/2 tab Prascend.  Tho he tests normal on the ACTH is is better on the Prascend.  My vet says we treat the horse not the test results, we use them as a guide.   He is a really awesome vet and we are lucky to have him....  All the best and ps I LOVE you podcast... the one with Dr Debra Taylor is my most favorite one... so informative.  Thank you for doing those.  Look forward to meeting you one day.
--
Nancy K
Smoke and Tucky
November 2018, Southeast, MA

Smoke Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Smoke
Smoke Photo Album:    https://ecir.groups.io/g/CaseHistory/album?id=94122
Tucky Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Tuck 
Tucky Photo Album:


Nancy & Vinnie & Summer
 

How high should insulin be to consider thinking about using Invokana? Vinnies was never higher than 88, but I feel like he could be a candidate. My vet did not want to use metformin to save for in case if a laminitis due to diminished efficacy.  We are seemingly at that point now..


--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Jennifer Murphy
 

Dr. Kellon - Tylenol was stopped back in June, and he hasn't been on it since I read here that it's not recommended.  He won't take bute, so he's not on anything specifically for pain.  I've seen phyto-quench and move ease mentioned, but wasn't sure if they addressed that level of pain; should I put him on one or the other? 

Nancy, I'm not sure what's considered high enough for Invokana, but Flea tends to test well over 100 and this year has been over 200 three tests now in June, September, and October.  If I can get his insulin below 100, I'll probably weep for joy!
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Eleanor Kellon, VMD
 

Jennifer,

I hope you can locate a vet to work with you on this. I understand the resistance with it being new, untested, unstudied, etc. but we're doing our best to keep the horses safe and well monitored. I just sent your vet another e-mail with updated information.

You could certainly try him on Phyto-Quench pellets in the meantime https://uckele.com/phyto-quench-pellet.html . Try 1/2 scoop twice a day and you can double that if you need to. What he really needs is to get that insulin down but hopefully this will help.

To answer your question about winter pain and Invokana, the answer is yes - in cases that have had that history it stops that too.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001