What Is Januvia For?

Patients living with type 2 diabetes can benefit from lifestyle changes like eating a healthy diet and engaging in exercise. When lifestyle modifications are not enough, medication can help patients achieve their blood sugar goals. While there are many treatment options on the market, Januvia stands out as a once-daily prescription pill.

What Is Januvia For?

Januvia, also known as sitagliptin, is a medication for adult patients with type 2 diabetes. This is a common metabolic disorder that results from the body’s inability to regulate glucose, a kind of sugar, in the blood. Over time, elevated glucose levels can cause serious complications, including heart disease, kidney disease, vision loss, and lower-limb amputation.

Typically, after meals, glucose enters the bloodstream and prompts the pancreas to release insulin, a type of hormone that signals cells to take up glucose from the blood. However, in type 2 diabetes, cells become resistant to insulin signals. They require higher levels of insulin to achieve the same glucose-lowering effect. Over time, pancreatic cells can’t keep up with this increased demand, leading to insufficient insulin production and elevated blood sugar levels. This dysregulation ultimately results in a diagnosis of type 2 diabetes.

When used in combination with diet and exercise, Januvia helps maintain healthy blood sugar levels. Doctors can make sure that Januvia is effective with a simple blood test, called an A1C test, which measures average blood sugar over the past 2-3 months. A target A1C goal is generally less than 7% but can vary based on patient factors and medical history.

It’s important to note that Januvia is not intended for people with type 1 diabetes or to treat diabetic ketoacidosis, a serious, life-threatening complication of diabetes where the body does not produce enough insulin. Additionally, safety and efficacy have not been established in children under 18 years old or in patients with a history of inflamed pancreas (pancreatitis).

What Does Januvia Do in the Body?

After eating, the body produces additional hormones to increase the release of insulin from the pancreas. These hormones, glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), are secreted in the gastrointestinal (GI) tract and are known collectively as incretins. The role of incretins is to increase the secretion of insulin while suppressing the secretion of glucagon, a hormone that counteracts insulin by stimulating glucose production in the liver during fasted states when blood sugar levels are too low. In the body, incretins are broken down and inactivated by the enzyme DPP-4.

Januvia belongs to a class of diabetes medications called DPP-4 inhibitors. By blocking the enzyme, GLP-1 and GIP remain activated to promote insulin release and limit glucagon release. By taking Januvia, insulin levels are increased to lower blood sugar, and glucagon levels are suppressed to limit the amount of sugar released into the bloodstream.

Januvia Dosing Guide

Common Strengths: Januvia 100 mg vs Januvia 25 mg

For most adults with type 2 diabetes, Januvia should be dosed at 100 mg taken by mouth once daily. However, this medication may need to be adjusted for patients with kidney problems, depending on the stage of damage. This is based on the estimated glomerular filtration rate (eGFR), a value which approximates how well kidneys are functioning and filtering out waste products. According to the prescribing guidelines, the following dose adjustments should be made based on a patient’s eGFR value:

• For patients with an eGFR greater than or equal to 45 mL/min/1.73 m², no dosage adjustment for Januvia is required
• For patients with moderate renal impairment (eGFR greater than or equal to 30 mL/min/1.73 m² to less than 45 mL/min/1.73 m²), the dose of Januvia is 50 mg once daily
• For patients with severe renal impairment (eGFR less than 30 mL/min/1.73 m²) or with end-stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis, the dose of Januvia is 25 mg once daily

Patients should talk to their doctor to determine the appropriate treatment dose before beginning Januvia. Healthcare providers should monitor kidney function during treatment to ensure the medication is working safely and effectively.

Januvia Starting Dose and Januvia Maximum Dose Explained

The starting dose of Januvia is 100 mg once daily. This is also the maximum dose that should be taken, so patients will not need dose increases. In clinical studies, taking a dose higher than 100 mg once daily was not shown to be more effective at blood sugar control. However, taking a dose higher than recommended can contribute to unwanted side effects and potential kidney damage.

When Is the Best Time to Take Januvia?

One of the benefits of Januvia is that it can be taken any time of day, with or without food.  Patients may find it helpful to incorporate taking their medication into another part of their daily routine. This can include taking Januvia right after waking up, or even during mealtimes. Setting an alarm can also help patients remember to take their medications. Taking Januvia at the same time every day can help patients remember to take the pill and stay consistent with their routine.

Common and Serious Januvia Side Effects

Common Side Effects of Januvia

The most common side effects of Januvia include:

• Stuffy or runny nose
• Upper respiratory tract infections with symptoms like cough and sore throat
• Headache

These mild side effects will usually go away as the body adjusts to the medication. They can also be managed with over-the-counter remedies if needed. Patients should report persistent or bothersome side effects to their doctor, but should not discontinue Januvia without guidance.

In clinical trials, when Januvia was used with other medications for type 2 diabetes, some patients had blood sugar levels drop to below a normal range. This is a condition called hypoglycemia, which can happen because the medications have additive effects when used together. Januvia on its own is unlikely to cause hypoglycemia since it works less when blood sugar levels are low. If patients use other medications such as sulfonylureas or insulins, the dose of those medications may need to be reduced before adding Januvia to their treatment plan. Signs of hypoglycemia include shakiness, dizziness, sweating, and faster heart rate.

Mild to moderate hypoglycemia can be treated using the “15-15” rule, where patients can consume 15 grams of a fast-acting carbohydrate like sugar cubes to raise their blood sugar. After 15 minutes, patients should check that their blood sugar levels are above 70 mg/dL using a glucometer. If blood sugar levels are still too low, patients can eat another 15 grams of carbohydrate and repeat until blood glucose levels are normal.

Serious or Rare Side Effects

Severe hypoglycemia is a rare side effect of using Januvia in combination with other medications. It is a medical emergency and can cause loss of consciousness and seizures. If a person shows signs of severe hypoglycemia, call 911 and obtain emergency medical care. Severe hypoglycemia is treated using a glucagon injection, which is available by prescription from a doctor.

Januvia can also cause an inflamed pancreas, a condition called pancreatitis. This causes severe abdominal pain from the abdomen through to the back and/or vomiting. If patients show signs of pancreatitis, they stop taking Januvia and contact a healthcare professional. This condition can be serious and lead to death if untreated.

Other drugs in the same class as Januvia have been shown to increase the risk of heart failure.  In clinical trials evaluating Januvia, the results on heart failure risk were conflicting, making it unclear whether the medication increases this risk. Before starting Januvia, patients should discuss their cardiovascular health with their doctor, especially if they have risk factors such as kidney disease. If patients experience shortness of breath, rapid increase in weight, or swelling in their legs or feet, they may be experiencing signs of heart failure and should contact their health provider immediately.

Other serious side effects include:

• Kidney damage
• Severe joint pain
• Skin reactions such as blisters or erosions
• Severe allergic reactions that make breathing difficult

Though serious side effects are rare, patients should seek immediate medical attention if they experience any severe symptoms. They can be life-threatening and cause permanent damage if untreated.

Does Januvia Cause Weight Gain?

Weight management is important for patients with type 2 diabetes to improve blood sugar levels and reduce the risk of cardiovascular disease. Fortunately, Januvia does not cause weight gain. It is considered “weight neutral,” meaning that it will not cause patients to lose or gain weight from the medication alone. When patients take Januvia and make healthier lifestyle choices, they may see weight loss, but it is not due to the mechanism of the drug itself.

Januvia Contraindications and Warnings

Januvia is contraindicated in patients who have had severe allergic reactions to the medication or any of its ingredients. This medication should be used with caution in patients who have had serious allergic reactions to other DPP-4 inhibitors. Signs of severe allergic reactions include rash and swelling of the face and throat that can make it difficult to breathe. Patients could potentially develop Stevens-Johnson syndrome, a severe and life-threatening reaction to medications that causes skin rashes, blistering, and peeling. Januvia can also cause angioedema, swelling of tissues under the skin. Angioedema can affect the face and throat, which may make breathing difficult.

Before starting Januvia, patients should discuss their full medical history with their healthcare provider. While many patients take Januvia without experiencing side effects, Januvia may place patients at risk for developing pancreatitis, heart failure, kidney failure, and severe joint pain. Knowing the symptoms of these conditions can help patients recognize if they are experiencing a severe side effect and prompt them to seek urgent treatment.

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Januvia vs Metformin: Which Is Better for Type 2 Diabetes?

Metformin is another medication commonly used to treat type 2 diabetes, but it works differently than Januvia. Metformin improves blood sugar levels by:

• Reducing the amount of sugar absorbed in the intestines after eating
• Limiting sugar production in the liver
• Increasing the amount of sugar taken up by cells from the blood
• Improving the body’s response to insulin

According to diabetes guidelines, metformin is a first-line treatment. Like Januvia, metformin is a tablet that should be taken by mouth, but it can be dosed one to three times daily and must be taken with meals. Both medications are used in conjunction with a healthy diet and exercise. When compared to DPP-4 inhibitors like Januvia, metformin is more effective at lowering A1C levels and weight. It is also cheaper and readily available at pharmacies. A benefit of Januvia is that it can be used in patients with severe kidney disease but metformin cannot. Also, metformin cannot be started for patients with moderate kidney failure; however, if patients are already on metformin when diagnosed with moderate kidney failure, they can continue taking it at a reduced dose. Patients diagnosed with heart failure and who are taking medications to manage it should not use metformin.

In terms of side effects, both medications do not cause weight gain and have low risk for hypoglycemia. The most common effects of metformin are gastrointestinal, including diarrhea, nausea, and vomiting. These side effects subside with continued use and can be minimized by using lower doses and formulations that release the medication over a longer period of time. Metformin may not be the best option for patients with vitamin B12 (cyanocobalamin) insufficiency, since the medication decreases the amount absorbed by the body.

Metformin has a black box warning for lactic acidosis, a rare yet life-threatening condition where blood becomes too acidic and can cause hypotension, hypothermia, and even death. Excessive alcohol intake can increase the risk of lactic acidosis and should be consumed in limitation for patients using metformin to manage their diabetes.

Both metformin and Januvia are viable options for reducing blood sugar levels, but one drug may be more appropriate for a patient based on their medical history and chance of developing side effects.

Januvia vs Farxiga: How Do They Compare?

Farxiga, also known as dapagliflozin, is another option for treating type 2 diabetes. This medication works in the kidneys to increase the amount of sugar excreted in urine and limit how much gets reabsorbed into the blood. Both Farxiga and Januvia are available as tablet and should be taken by mouth once daily.

Besides its use for managing type 2 diabetes, Farxiga can reduce the risk of cardiovascular disease, including heart failure, and slow the progression of kidney failure in patients with kidney disease. It is a preferred treatment for patients with these comorbidities. Another benefit of this medication is that it can promote minor weight loss. Like Januvia, it has a low risk of causing hypoglycemia. Farxiga is safe for use in patients with moderate kidney disease and for patients with severe kidney disease who have been previously prescribed the drug. However, patients should not start Farxiga if they have been diagnosed with severe kidney disease and have not previously used it.

The side effects of Farxiga primarily involve the genitourinary system, including increased urine output and risk of urinary tract infections or fungal infections in females. These urinary tract infections can become serious if untreated. Farxiga has been known to cause Fournier’s Gangrene, a genital infection that leads to tissue death. Patients should contact their doctor as soon as possible if they develop pain, tenderness, redness, or swelling in their genital or rectal area.

Other severe side effects of Farxiga include ketoacidosis, a life-threatening condition when the blood becomes too acidic. Patients should be aware of symptoms of ketoacidosis, such as nausea or vomiting, abdominal pain, tiredness and labored breathing. If ketoacidosis occurs, patients should seek urgent medical attention and discontinue treatment. Another severe side effect is volume depletion and dehydration since the medication increases urine output. This can lead to hypotension, or low blood pressure, with symptoms of dizziness, fatigue, and fainting.

Before deciding between Januvia and Farxiga for diabetes management, it is important to compare differences in how they work, their potential health benefits, and possible side effects. Selecting the most appropriate option should involve balancing blood sugar goals with overall health considerations.

Who Should and Shouldn’t Take Januvia

Patients SHOULD take Januvia if they:

• Have type 2 diabetes
• Need lower blood sugar levels that can’t be achieved with diet and exercise alone
• Prefer a once daily pill that can be taken at any time

Patients SHOULD NOT take Januvia if they:

• Have type 1 diabetes
• Are experiencing diabetic ketoacidosis
• Have a history of heart failure, pancreatitis, or allergies to any of Januvia’s ingredients
• Show severe side effects from the medication

Final Thoughts: Is Januvia Right For You?

Januvia is a once-daily pill that helps lower blood sugar along with diet and exercise. It works by increasing the amount of sugar taken into cells from the bloodstream and by decreasing the amount of sugar made by the body. Maintaining healthy levels of blood sugar can help prevent or delay complications of diabetes, such as heart disease, kidney disease, blindness, and lower-limb amputation. Januvia is usually taken by mouth as a 100 mg tablet, though the dose may be adjusted for patients with kidney damage. The most common side effects include stuffy or runny nose, cough, sore throat, and headaches. Serious side effects are rare but can occur even if Januvia is taken properly. Patients and doctors should have an open conversation about health history and blood sugar goals before deciding that Januvia is the right choice for diabetes management.