What to Know About Januvia (Sitagliptin)

In This Article

Januvia (sitagliptin) is an oral medication (pill) used in conjunction with diet, exercise, and other drugs to help lower blood glucose levels in people with type 2 diabetes. Januvia belongs to a class of drugs called DPP-4 inhibitors that work by blocking an enzyme called dipeptidyl peptidase IV that is responsible for breaking down the proteins that stimulate insulin production after a meal. If DPP-4 is inhibited, these proteins can activate the release of insulin for a longer period of time, thereby lowering the glucose level in the blood.

Januvia was the first DPP-4 inhibitor approved by the Food and Drug Administration (FDA) in the United States, in 2006. It cannot be purchased as a generic, but is available combined with metformin in a medication called Janumet and with ertugliflozin as Steglujan. It is not approved to treat type 1 diabetes or diabetic ketoacidosis.

Uses

Januvia is used expressly as a second- or third-line medication for treating type 2 diabetes, a chronic condition that affects the way the body metabolizes sugar (glucose). It is meant to be part of a diabetes management protocol that includes diet, exercise, and other medications—specifically metformin or thiazolidinediones.

Before Taking

Your doctor may suggest you take Januvia if you've been unable to control your blood glucose with diet, exercise, and first-line medications, such as metformin or a sulfonylurea.

Your doctor may prescribe Januvia instead of other, less expensive second-line diabetes medications because it is unlikely to cause hypoglycemia or weight gain. Januvia only works when it's needed, generally at mealtimes, so if there is no glucose in the blood, then there is no action from Januvia. If glucose levels rise, such as after a meal, then Januvia will work to lower that level.

Precautions and Contraindications

If you have or have had pancreatitis, tell your doctor about it before taking Januvia. Some people taking Januvia have experienced pancreatitis, though it's currently not known whether the medication is the cause. There have also been rare reports of kidney and heart failure in people taking Januvia or other DPP-4 inhibitors.

Januvia should not be used by people who are experiencing diabetic ketoacidosis. Women who are pregnant or nursing also should not take Januvia, since little is known about its effects in pregnancy or when nursing.

Dosage

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you. Your doctor will review your kidney function prior to establishing the right dosing schedule for you and will periodically review your kidney health thereafter.

For people with no kidney function issues, Januvia comes in a 100 milligram (mg) tablet for once-daily dosing. For people with moderate kidney function, a 50 mg tablet is available. For those with severe kidney disease, a 25 mg tablet is available. In both cases the dosing remains once-daily.

How to Take and Store

Januvia does not need to be taken with food. It should be stored at room temperature.

Side Effects

The most commonly reported side effects of Januvia include upper respiratory infection, sore throat, and headache.

Severe

Rarely, some people experience severe allergic or skin reactions to Januvia, including anaphylaxis. If you develop hives, swelling in your throat or difficulty breathing, blisters, a skin rash, or other severe reactions, stop taking Januvia and get emergency medical assistance.

Another severe side effect associated with Januvia to be aware of is an increased risk for pancreatitis. Your doctor will evaluate your pancreas function soon after you start Januvia and at regular intervals thereafter. Stop taking Januvia and call your doctor right away if you develop severe pain in your abdomen that will not go away. The pain may feel as if it goes from your abdomen through to your back and be accompanied by vomiting. These may be symptoms of pancreatitis. 

Warnings and Interactions

Since Januvia is processed through the kidneys, your doctor will assess your renal (kidney) function before you take Januvia. People who have impaired renal function may need to take lower doses of Januvia lowered, since there have been rare reports of kidney failure when taking Januvia.

A risk of heart failure has also been reported with DPP-4 inhibitors that may be increased by impaired liver or kidney function. If you have any of these conditions, ask your doctor whether the benefits of Januvia outweigh the risks for you, and be sure to keep up with regular testing.

While Januvia is unlikely to lower blood sugar on its own, if you're combining Januvia with medications that do lower blood sugar, such as a sulfonylurea or insulin, you'll also need to watch for hypoglycemia.

Januvia and other DPP-4 inhibitors can cause severe joint pain in some people who take them. In 2015, the FDA added a warning regarding this side effect to gliptin drug labels. The symptoms can start immediately or begin years after taking a gliptin drug. In cases reported to the FDA, people who stopped taking DPP-4s stopped experiencing joint pain within a month. If you experience joint pain, contact your doctor so they can adjust your medications if necessary.

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  1. Pathak R, Bridgeman MB. Dipeptidyl Peptidase-4 (DPP-4) inhibitors in the management of diabetes. P T. 2010;35(9):509-13. 

  2. Karasik A, Aschner P, Katzeff H, Davies MJ, Stein PP. Sitagliptin, a DPP-4 inhibitor for the treatment of patients with type 2 diabetes: a review of recent clinical trials. Curr Med Res Opin. 2008;24(2):489-96. doi:10.1185/030079908X261069 

  3. Merck Sharp & Dohme Corp. Possible risks and side effects of januvia.

  4. Merck Sharp & Dohme Corp. Januvia: Dosing and administration. Last reviewed September 2020.

  5. Pinto LC, Rados DV, Barkan SS, Leitão CB, Gross JL. Dipeptidyl peptidase-4 inhibitors, pancreatic cancer and acute pancreatitis: A meta-analysis with trial sequential analysis. Sci Rep. 2018;8(1):782. doi:10.1038/s41598-017-19055-6

  6. Xia C, Goud A, D'souza J, et al. DPP4 inhibitors and cardiovascular outcomes: safety on heart failure. Heart Fail Rev. 2017;22(3):299-304. doi:10.1007/s10741-017-9617-4

  7. Food & Drug Administration. FDA drug safety communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain. 2015.

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