Januvia (sitagliptin)

Diabetes

What is Januvia?

Januvia is a brand-name prescription medication. It’s used together with diet and exercise to treat type 2 diabetes. Your doctor may want you to take Januvia by itself or with other drugs that also treat diabetes. Januvia isn’t used to treat type 1 diabetes.

Januvia is a type of drug called a dipeptidyl peptidase-4 (DPP-4) inhibitor. These medications help keep your insulin levels stable and reduce the amount of glucose (blood sugar) that your body makes.

Januvia comes as a tablet that you swallow. The drug is available in three different strengths: 25 mg, 50 mg, and 100 mg.

Effectiveness

Januvia has been found to be effective (work well) in people with type 2 diabetes.

In a clinical study, 229 people took Januvia for 24 weeks. These people hadn’t taken any diabetes drug for seven weeks. By the end of the study, the people who took Januvia had A1C levels that were 0.6% lower than before they started taking the drug. People who took a placebo (no treatment) had A1C levels that were 0.2% higher at the end of the study. A1C measures how well your blood sugar is controlled over a few months.

For more about effectiveness, see the “Januvia uses” section below.

Januvia generic

Januvia is available only as a brand-name medication. It’s not currently available in generic form.

Januvia contains the drug sitagliptin. This medication is a type of a dipeptidyl peptidase-4 (DPP-4) inhibitor.

Januvia side effects

Januvia can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Januvia. These lists don’t include all possible side effects.

For more information on the possible side effects of Januvia, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Januvia can include:

  • upper respiratory infections, such as the common cold or a sinus infection
  • runny or stuffy nose
  • headache

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Januvia aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Hypoglycemia (low blood sugar). Symptoms can include:
    • confusion
    • dizziness
    • drowsiness (feeling sleepy or tired)
    • fast heartbeat
    • feeling jittery (nervous)
    • headache
    • hunger
    • feeling irritable (easily upset or frustrated)
    • sweating
    • weakness
  • Serious allergic reactions. Symptoms can include:
    • skin reactions such as Steven-Johnson syndrome (painful sores on your mouth, throat, eyes, or genitals)
    • anaphylaxis (a type of severe allergic reaction that can include low pulse rate, rash, sudden drop in blood pressure, and trouble breathing)
    • angioedema (swelling under your skin, typically in your eyelids, lips, hands, or feet)
  • Kidney problems. Symptoms can include:
    • coma
    • confusion
    • excessive drowsiness (sleepiness) or fatigue (lack of energy)
    • pain or pressure in your chest
    • nausea that lasts a long time
    • reduced amount of urine
    • seizures
    • swelling of your legs, ankles, and feet
    • unexplained shortness of breath
  • Joint pain, swelling, and stiffness. Symptoms can include:
    • not being able to move your joints
    • severe joint pain
  • Pancreatitis. Symptoms can include:
    • tender abdomen (belly)
    • swollen abdomen
    • indigestion (upset stomach)
    • nausea or vomiting
    • hiccups
    • losing weight without trying
    • pain in your upper body
    • fever

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on some of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Januvia. Allergic reactions to Januvia occur within three months of starting the medication. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Januvia. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Pancreatitis

In 19 clinical studies, 0.1% of people who took Januvia developed pancreatitis. This is a swelling of the pancreas, the organ that creates the hormone insulin. When your pancreas is swollen, your body may not be able to make insulin as well.

Tell your doctor if you’ve had pancreatitis or have any symptoms of it (see the “Serious side effects” section above). Your doctor may have you stop taking Januvia and may prescribe a different medication.

Pancreatic cancer

Pancreatic cancer (cancer of the pancreas) wasn’t reported as a side effect in any clinical study of Januvia. But there have been concerns about whether Januvia may increase your chance of developing pancreatic cancer.

A clinical study looked at the health history of 71,137 people who took Januvia. In this group, 83 people developed pancreatic cancer. However, this study only examined people’s health history. Researchers weren’t specifically looking for an increased risk of pancreatic cancer in people who took Januvia.

Further studies are needed to confirm a link between Januvia and an increased chance of developing pancreatic cancer. The Food and Drug Administration (FDA) has alerted healthcare providers about the possible link and is investigating further.

If you have any concerns about pancreatic cancer while taking Januvia, talk with your doctor.

Hypoglycemia

Januvia rarely causes hypoglycemia (low blood sugar) when taken by itself. In clinical studies, 1.2% of people who only took Januvia had low blood sugar.

But when Januvia is combined with other medications that treat diabetes, the risk of hypoglycemia increases. Hypoglycemia can cause less sugar to go to your cells and organs, which can make them not work as well.

In clinical studies, 15.5% of people who took Januvia and insulin had at least one episode of hypoglycemia. In people who took Januvia with the diabetes drug glimepiride, the rate of hypoglycemia was 12.2%.

If you have symptoms of hypoglycemia (see the “Serious side effects” section above), tell your doctor. They may adjust your dose of Januvia or other diabetes medications to control the amount of sugar in your blood.

Heart failure

Heart failure wasn’t reported as a side effect in any clinical study of Januvia. Heart failure occurs when your heart can’t pump enough blood to the rest of your body.

However, according to the FDA, diabetes drugs similar to Januvia, including Onglyza and Nesina, have been shown to increase the risk of heart failure. These medications are in the same class as Januvia and have similar effects in your body.

If you’ve had heart failure in the past, taking Januvia may increase your chance of developing the condition again. See the “Januvia precautions” section below to learn more.

Tell your doctor if you have a history of heart failure. They may adjust your treatment and prescribe a medication other than Januvia.

Cancer

Januvia likely doesn’t cause cancer. No clinical trials of Januvia reported cancer as a side effect.

However, a study in Taiwan found that people who took Januvia had a higher chance of developing thyroid cancer. This was compared to people who had diabetes but didn’t take Januvia. Yet no clinical studies in the United States have linked Januvia to thyroid cancer.

If you’re taking Januvia and are concerned about thyroid cancer, talk with your doctor.

Interestingly, some evidence shows that Januvia may have a positive effect on other types of cancer. Three more studies in Taiwan, such as this 2017 study, suggest that taking Januvia may reduce the chance of developing oral cancer, breast cancer, and prostate cancer.

Joint pain

Pain in your joints is a possible side effect of taking Januvia. Joint pain is also a side effect of diabetes drugs that are similar to Januvia. More studies are needed to know the specific risk of having joint pain while taking Januvia.

If you have sore joints, let your doctor know. They can recommend treatments to help you feel more comfortable. Or they might have you stop taking Januvia and use another diabetes medication instead.

Diarrhea

Januvia likely doesn’t cause diarrhea. In clinical studies, diarrhea wasn’t a common side effect in people who took Januvia by itself. However, some studies have shown that people who took Januvia with other diabetes drugs did have diarrhea.

In these clinical studies, the overall rate of diarrhea was 3% when Januvia was taken by itself or with other diabetes drugs. This included people who took metformin, which is a common cause of diarrhea.

If you have diarrhea while taking Januvia and other diabetes drugs, drink a lot of water. Call your doctor if the diarrhea lasts longer than three days. Your doctor can recommend treatments to help ease your symptoms. They may also adjust the dosage of your diabetes medications.

Kidney effects

It’s not clear whether Januvia causes kidney problems. No clinical studies have linked the use of Januvia to kidney problems. But some people have reported kidney problems after taking Januvia, including kidney failure. Also, kidney problems may limit the amount of Januvia that leaves your body. This may increase the amount of Januvia in your blood and lead to severe side effects.

If you have or had any kidney problems, let your doctor know right away. Also, tell your doctor if you have symptoms of kidney failure. These can include pain or pressure in your chest or swelling of your legs, ankles, and feet.

Before and while you take Januvia, your doctor will give you blood tests to see how your kidneys are working. Your doctor may adjust your dosage of Januvia to make sure it doesn’t harm your kidneys.

Skin rash

Januvia doesn’t typically cause skin rashes. However, skin rashes can be a symptom of an allergic reaction to Januvia. (See the “Allergic reaction” section above.)

If you notice a rash on your skin, let your doctor know. They can recommend treatments to help ease your symptoms. Your doctor may also have you stop taking Januvia and use a different medication instead.

Edema (swelling)

Januvia likely doesn’t cause edema (fluid buildup in your body). Edema wasn’t reported as a side effect in people who took Januvia by itself. However, people who took Januvia with other diabetes drugs did have edema. Symptoms of edema can include swelling in some parts of your body, such as your hands and legs.

In a clinical study, 8.3% of people who took Januvia together with metformin and pioglitazone (other medications for diabetes) had edema. This was compared to 5.2% of people who took a placebo (no treatment).

In some cases, edema may be temporary and will go away on its own. But if your edema doesn’t go away, tell your doctor. They can recommend treatments to ease your symptoms. Your doctor may also adjust the dosage of your diabetes medications.

Weight loss (not a side effect)

Weight loss wasn’t reported as a side effect in any clinical trials of Januvia.

However, other studies have looked at whether Januvia may help people lose weight. In one small clinical study, people with high cholesterol who took Januvia to treat their type 2 diabetes lost about 18 lbs. after 12 weeks.

If you’re taking Januvia and you want to lose weight or avoid losing weight, talk with your doctor. They may adjust your diet and exercise routine based on your needs. They may also recommend a dietitian to help make sure you get proper nutrition.

Januvia’s use in people without diabetes who want to lose weight has been studied in one small trial. People in this study had high blood pressure and high cholesterol, but didn’t have diabetes. After taking Januvia for three months, they lost 6.5% of their body weight.

Januvia isn’t approved for weight loss, and more studies are needed before it can be recommended. If you don’t have diabetes and want to lose weight, talk with your doctor.

Weight gain (not a side effect)

Weight gain wasn’t reported as a side effect in any clinical study of Januvia.

In some cases, your doctor may want you to take insulin along with Januvia. Keep in mind that it’s common to gain weight while taking insulin.

But if you’re concerned about weight gain, let your doctor know. They may adjust your diet and exercise routine as needed.

Constipation (not a side effect)

No clinical studies have linked the use of Januvia with constipation. However, constipation can be the result of a pancreatitis, which is a possible side effect of taking Januvia (See the “Pancreatitis” section above). Type 2 diabetes can also cause constipation.

If you have constipation on a regular basis, let your doctor know. They’ll try to see what’s causing it. They’ll also recommend treatments to help ease your symptoms.

Hair loss (not a side effect)

No clinical studies have linked the use of Januvia with hair loss. But type 2 diabetes may cause hair loss in some people.

If you’re concerned about hair loss, let your doctor know. They may give you some tests to see what’s causing it. Your doctor may also give you tips on how to cope with hair loss.

Erectile dysfunction (not a side effect)

No clinical studies have linked the use of Januvia with erectile dysfunction (ED). But type 2 diabetes may cause ED in some men.

If you have ED, let your doctor know. They can recommend treatments to help ease your symptoms.


Januvia dosage

The Januvia dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Januvia to treat
  • your age
  • other medical conditions you may have
  • how well your kidneys work

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Januvia comes as a tablet that you swallow. It’s available in three different strengths: 25 mg, 50 mg, and 100 mg.

Dosage for type 2 diabetes

Januvia is typically prescribed in dosages of 100 mg, once a day. It doesn’t matter if you take the drug with or without food.

If your kidneys aren’t working well, your doctor may give you a different dosage of Januvia. Differences in dosages can be more common in older adults. This is because their kidneys may work less well as they age.

If you have questions about your Januvia dosage, talk with your doctor.

What if I miss a dose?

If you realize that you’ve missed a dose of Januvia, take it as soon as you can. But don’t take two or more doses in one day.

It may help to take your medication at the same time each day so it becomes routine. Medication reminders can help make sure that you don’t miss a dose. Consider using them if you have problems remembering when to take Januvia.

Will I need to use this drug long term?

Januvia is meant to be used as an ongoing treatment. If you and your doctor determine that Januvia is safe and effective for you, you’ll likely take the drug long term.

Januvia cost

As with all medications, the cost of Januvia can vary. To find current prices for Januvia in your area, check out GoodRx.com:

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Financial and insurance assistance

If you need financial support to pay for Januvia, or if you need help understanding your insurance coverage, help is available.

Merck, the manufacturer of Januvia, offers savings coupons to help lower the cost of Januvia. For more information and to find out if you’re eligible, visit the program website.


Januvia uses

The Food and Drug Administration (FDA) approves prescription drugs such as Januvia to treat certain conditions.

Januvia for type 2 diabetes

Januvia is FDA-approved to treat type 2 diabetes, along with diet and exercise. Your doctor may want you to take Januvia by itself or with other drugs that also treat diabetes. Some of the medications that have been found effective with Januvia include:

  • metformin
  • pioglitazone
  • rosiglitazone
  • glimepiride
  • insulin

Januvia isn’t approved by the FDA for type 1 diabetes. If you have type 1 diabetes or want to lose weight, talk with your doctor. They’ll discuss possible treatment options with you.

In one clinical study that lasted 18 weeks, Januvia was tested in 193 people with type 2 diabetes. At the start of the study, the people hadn’t taken any diabetes drug for at least seven weeks.

By the end of the study, the people who took Januvia had A1C levels that were 0.5% lower than before they started taking the drug. People who took a placebo (no treatment) had A1C levels that were 0.1% higher at the end of the study. A1C measures how well your blood sugar is controlled over a few months.

In a 24-week clinical study of people with type 2 diabetes, Januvia reduced A1C levels 0.8% more than placebo (no treatment).

Studies of Januvia taken with other diabetes medications may have different results.

Note: Januvia isn’t approved for weight loss. See the “Side effect details” section above for more information.

Januvia use with other drugs

The Food and Drug Administration (FDA) has approved Januvia to treat type 2 diabetes, in addition to diet and exercise. Your doctor may recommend that you take Januvia by itself or with other medications that also treat diabetes. Some of these other drugs may include:

  • metformin
  • pioglitazone
  • rosiglitazone
  • glimepiride
  • insulin


Alternatives to Januvia

Other drugs are available that can treat your condition. Some may be better suited for you than others. If you’re interested in finding an alternative to Januvia, talk with your doctor. They can tell you about other medications that may work well for you.

Alternatives for type 2 diabetes

Examples of other drugs that may be used to treat type 2 diabetes include:

  • linagliptin (Tradjenta)
  • metformin (Glucophage, Glucophage XR, Fortamet, Glumetza)
  • empagliflozin (Jardiance)
  • canagliflozin (Invokana)
  • saxagliptin (Onglyza)
  • alogliptin (Nesina)
  • glipizide (Glucotrol and Glucotrol XL)
  • sitagliptin and metformin hydrochloride (Janumet)
  • pioglitazone (Actos)
  • glimepiride (Amaryl)
  • liraglutide (Victoza)
  • dulaglutide (Trulicity)
  • dapagliflozin (Farxiga)
  • semaglutide (Ozempic)

Januvia vs. Tradjenta

You may wonder how Januvia compares to other medications that are prescribed for similar uses. Here we look at how Januvia and Tradjenta are alike and different.

Uses

The Food and Drug Administration (FDA) has approved both Januvia and Tradjenta to treat type 2 diabetes in adults, along with diet and exercise.

Januvia contains the drug sitagliptin. Tradjenta contains the drug linagliptin.

Januvia and Tradjenta belong to the same class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. This means that they work in similar ways in your body.

Drug forms and administration

Januvia comes as a tablet that you swallow. It’s available in three different strengths: 25 mg, 50 mg, and 100 mg. Januvia is typically prescribed in dosages of 100 mg, once a day.

Tradjenta also comes as a tablet that you swallow. It’s available in one strength: 5 mg. The recommended dosage is 5 mg, once a day.

Both Januvia and Tradjenta can be taken with or without food.

Side effects and risks

Januvia and Tradjenta both work in the same way. So both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Januvia, with Tradjenta, or with both drugs (when taken individually).

  • Can occur with Januvia:
    • runny or stuffy nose
    • headache
  • Can occur with Tradjenta:
    • cough
    • diarrhea
  • Can occur with both Januvia and Tradjenta:
    • upper respiratory infections, such as the common cold or a sinus infection

Serious side effects

These lists contain examples of serious side effects that can occur with Januvia, with Tradjenta, or with both drugs (when taken individually).

  • Can occur with Januvia:
    • kidney failure
  • Can occur with Tradjenta:
    • few unique serious side effects
  • Can occur with both Januvia and Tradjenta:
    • joint pain
    • skin reactions
    • pancreatitis
    • hypoglycemia (low blood sugar)

Effectiveness

Januvia and Tradjenta are both FDA-approved to treat type 2 diabetes, along with diet and exercise.

Separate studies of the two drugs were compared in a larger review of studies. Researchers looked at how well Januvia and Tradjenta helped lower A1C levels. This is a measure of how well your blood sugar is controlled over a few months. Januvia was found to be as effective as Tradjenta.

Costs

Januvia and Tradjenta are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Januvia generally costs more than Tradjenta. The actual price you’ll pay for either drug will depend on your insurance plan, your location, and the pharmacy you use.

Januvia vs. metformin

In addition to Tradjenta (above), metformin is also used to treat type 2 diabetes. Here we look at how Januvia and metformin are alike and different.

Uses

The Food and Drug Administration (FDA) has approved both Januvia and metformin to treat type 2 diabetes in adults, along with diet and exercise. Metformin is also approved to treat type 2 diabetes in children.

Januvia contains the drug sitagliptin. Metformin contains the drug metformin.

Januvia belongs to a class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. Metformin is part of the drug class called biguanides.

Januvia and metformin belong to different groups of drugs because they work in different ways.

Drug forms and administration

Both Januvia and metformin come as tablets that you swallow. Metformin also comes as a liquid medication that you swallow.

Januvia is taken once a day. Metformin can be taken from one to three times per day, depending on the dose.

Side effects and risks

Januvia and metformin have different effects on the body, so both medications can cause different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Januvia or with metformin.

  • Can occur with Januvia:
    • upper respiratory infections, such as the common cold or a sinus infection
    • headache
  • Can occur with metformin:
    • diarrhea
    • nausea
    • vomiting
    • weight loss
    • upset stomach or having gas

Serious side effects

These lists contain examples of serious side effects that can occur with Januvia, with metformin, or with both drugs (when taken individually).

  • Can occur with Januvia:
    • allergic reactions
    • kidney failure
    • joint pain
    • skin reactions
  • Can occur with metformin:
    • lactic acidosis (too much lactic acid in your body that can damage your liver)
    • low levels of vitamin B-12, which can lead to anemia (low levels of red blood cells) in rare cases
  • Can occur with both Januvia and metformin when used with other diabetes drugs:
    • hypoglycemia (low blood sugar)

Effectiveness

Januvia and metformin are both FDA-approved to treat type 2 diabetes, along with diet and exercise.

Separate studies of the two drugs were compared in a larger review of studies. Researchers looked at the results of seven clinical trials. They found that Januvia was as effective as metformin at improving A1C levels. A1C measures how well your blood sugar is controlled over a few months.

Costs

Januvia is a brand-name drug. Metformin is available as a brand-name drug (Glucophage, Fortamet, Riomet) and in a generic form. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Januvia generally costs more than metformin. The actual price you’ll pay for either drug will depend on your insurance plan, your location, and the pharmacy you use.

Januvia and alcohol

There aren’t known interactions between Januvia and alcohol. But drinking too much alcohol can decrease the level of glucose (sugar) in your blood. This can lead to a condition called hypoglycemia (low blood sugar). If you drink heavily on a regular basis and have low blood sugar, your blood sugar level may drop even more.

Also, drinking too much alcohol can damage your pancreas. If you’ve ever had a condition called pancreatitis (swollen pancreas), taking Januvia may cause your pancreatitis to flare up. Drinking alcohol may increase your chances of having pancreatitis while taking Januvia.

If you drink alcohol and are concerned about how it might interact with Januvia, talk with your doctor. They can tell you how much is safe for you to drink during your treatment.


Januvia interactions

Januvia can interact with several other medications. It can also interact with certain supplements as well as certain herbs.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Januvia and other medications

Below is a list of medications that can interact with Januvia. This list doesn’t contain all drugs that may interact with Januvia.

Before taking Januvia, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Birth control

Taking birth control pills with Januvia may make Januvia less effective (not work as well).

In addition to helping prevent pregnancy, the hormones in birth control pills can increase the amount of sugar in your blood. With this higher level of sugar in your blood, Januvia may not work as well.

If you’re using or want to use birth control pills while taking Januvia, talk with your doctor. They can recommend the best way to avoid becoming pregnant.

Digoxin

Taking Januvia with the heart medication digoxin (Lanoxin) can increase the amount of digoxin in your body. Too much digoxin can increase your chance of dangerous side effects, such as diarrhea, dizziness, and headache.

If you’re taking digoxin and Januvia, talk with your doctor. If you have different doctors for your heart condition and diabetes, tell them both about the drugs you take. They may monitor your health more closely.

Insulin

Insulin or drugs that help your body make insulin can interact with Januvia. Taking both medications together may cause your blood sugar level to drop and lead to hypoglycemia (low blood sugar).

Once you start taking Januvia, your doctor may adjust your dosage of insulin or insulin medications.

Januvia and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Januvia. But some herbs may help reduce the amount of sugar in your blood. Taking these herbs with Januvia may cause hypoglycemia (low blood sugar), which can be dangerous.

Some of the herbs and supplements that may help reduce the amount of sugar in your blood include:

  • aloe vera
  • Andrographis paniculata
  • astragalus (huáng qí)
  • Cassia fistula
  • Cassia occidentalis
  • fenugreek
  • garlic
  • ginger
  • ginseng
  • gymnema
  • karela (bitter melon)
  • lycium
  • olive leaf extract
  • prickly pear cactus (Nopal cactus)
  • scutellaria (skullcap)
  • sesame oil
  • St. John’s wort

If you’re taking any of these herbs or supplements, tell your doctor or pharmacist. They can advise you on whether they’re safe to use while taking Januvia.

How Januvia works

Managing the amount of glucose (sugar) in your blood is very important. Too much sugar can lead to hyperglycemia (high blood sugar). This is a condition in which sugar stays in your blood instead of going into your body’s cells. When your cells don’t have sugar to use for energy, some of your organs, including your kidney and heart, may become damaged over time.

Your body helps control the amount of sugar in your blood with a type of hormone called insulin. Hormones are substances that can control how certain cells and organs work.

With type 2 diabetes, your body develops insulin resistance. This means that your body can’t use insulin the right way. As the level of sugar in your blood increases, the level decreases in your cells and organs. So your pancreas tries to make more insulin to help control your blood sugar. But in most cases, your body won’t be able to make enough insulin.

When you have type 2 diabetes, you need to watch your diet. It’s important that you don’t consume too much food and drink that your body can make into sugar. Exercise is also vital. It helps reduce the amount of sugar in your blood. When you exercise, your muscles draw energy from sugar. So sugar moves from your blood into your muscles.

But in some cases, diet and exercise aren’t enough to reduce the amount of sugar in your blood. You may need to take medication to get your blood sugar to a safe level. Most of these drugs need to be taken for a long time.

What does Januvia do?

Januvia primarily works by increasing the amount of insulin in your body, which lowers your blood sugar levels.

Januvia stops the activity of a protein called dipeptidyl peptidase 4 (DPP-4). DPP-4 reduces the amount of two substances that decrease the amount of insulin in your body. These chemicals are called glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP).

By blocking DPP-4, Januvia increases the amount of GLP-1 and GIP in your body. This in turn increases the amount of insulin that your body makes. High levels of insulin then decrease the amount of sugar in your blood.

In addition, higher levels of GLP-1 cause your body to release less of a hormone called glucagon. This hormone increases the amount of sugar in your blood. So with less glucagon in your body, your blood sugar levels decrease.

How long does it take to work?

After taking Januvia, it may be about a week until your blood sugar level starts to decrease. Your sugar-monitoring tests may be a good way for you to check the amount of sugar in your blood.

Type 2 diabetes is a long-term condition, so Januvia treatment is long term as well. If the amount of sugar in your blood decreases, don’t stop taking Januvia unless your doctor tells you. If you suddenly stop taking the drug, your blood sugar level will increase again.

Januvia overdose

Using more than the recommended dosage of Januvia can lead to serious side effects.

Overdose symptoms

Symptoms of an overdose can include:

  • change in mental activity (including thinking and reasoning)
  • excessive sweating
  • heart palpitations (feeling of skipped or extra heartbeats)
  • tremor (uncontrollable shaking in a part of your body)

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to take Januvia

You should take Januvia according to your doctor or healthcare provider’s instructions.

When to take

You can take Januvia at any time, once a day. It’s better to take the drug at the same time each day. Your doctor can help you decide what time is best for you based on your schedule.

Medication reminders can help make sure that you don’t miss a dose.

Taking Januvia with food

It doesn’t matter if you take Januvia with or without food.

Can Januvia be crushed, split, or chewed?

Swallow the tablet whole with a glass of water.

If you have problems swallowing Januvia tablets, talk with your doctor. They can recommend strategies that make swallowing tablets easier. Or they may recommend other medications that are easier for you to take.


Januvia and pregnancy

There haven’t been clinical studies in humans to prove whether Januvia is safe to take during pregnancy. In animal studies, no problems were reported in the mother or fetus when the mother was given Januvia during pregnancy. But animal studies don’t always predict what happens in humans.

If you’re taking Januvia and become pregnant or want to become pregnant, tell your doctor. They can discuss your treatment options.

And ask your doctor about the clinical registry for pregnant women who are taking Januvia. Pregnancy registries collect information about you and your baby. They help doctors learn how certain drugs affect women and their pregnancies. Your doctor may recommend that you register.

Januvia and breastfeeding

There isn’t information about Januvia being present in breast milk in humans. Studies conducted in animals showed that the drug was present in breast milk. No harmful effects occurred to the baby animals. But animal studies don’t always predict what happens in humans.

If you’re taking Januvia and want to breastfeed, talk with your doctor. They can advise you on the best way to feed your child.


Common questions about Januvia

Here are answers to some frequently asked questions about Januvia.

Will I need to take insulin with Januvia?

Maybe. Januvia can be taken by itself or with insulin. Whether or not you need to take insulin depends on the amount of sugar in your blood. Your doctor will look at your lab tests and treatment history to decide whether you need insulin with Januvia.

If I have type 1 diabetes, can I use Januvia?

No. The Food and Drug Administration (FDA) hasn’t approved Januvia to treat type 1 diabetes. Januvia is only approved to treat type 2 diabetes.

Type 1 diabetes is thought to involve a problem with your immune system. Your immune system is what protects your body from infections. In people with type 1 diabetes, the immune system gets confused and attacks the production of insulin.

If you have type 1 diabetes, your body can’t make its own insulin. This means that Januvia can’t increase the amount of insulin that your body releases like it does in a person with type 2 diabetes.

However, it’s possible that Januvia might help people with type 1 diabetes in other ways. Some studies have suggested that Januvia improves blood sugar and lowers the amount of insulin that people with type 1 diabetes need. Other studies found no benefit of using Januvia for type 1 diabetes.

Until more studies are done, there isn’t enough information to recommend Januvia to treat type 1 diabetes. If you have type 1 diabetes, talk with your doctor. They can recommend the best treatment to help you manage your condition.

If I don’t have diabetes but want to lose weight, can I use Januvia?

No. Januvia is only approved to treat type 2 diabetes. The FDA hasn’t approved the drug to treat weight loss.

Januvia’s use in people without diabetes who want to lose weight has been studied in one small trial. People in this study had high blood pressure and high cholesterol, but didn’t have diabetes. After taking Januvia for three months, they lost 6.5% of their body weight.

More studies are needed before Januvia can be recommended for weight loss. If you don’t have diabetes and want to lose weight, talk with your doctor. They may adjust your diet and exercise routine based on your needs. They may also recommend a dietitian to help make sure you get the proper nutrition.

Are there any natural alternatives I can use instead of Januvia to help control my blood sugar?

Natural alternatives shouldn’t replace any diabetes medication that your doctor has prescribed for you. But researchers are studying how certain foods and supplements can increase or decrease the amount of sugar in your body.

Clinical studies looked at the effect of cinnamon on people with type 2 diabetes. These people took between 0.5 g and 6 g of cinnamon each day for 40 days to four months. In some studies, cinnamon was effective at improving blood sugar levels. In other studies, there was no benefit.

More studies are needed to confirm whether it’s effective and safe for people to take cinnamon for type 2 diabetes.

Another natural alternative that’s been researched is the mineral chromium. It may help reduce blood sugar levels. But according to a review of clinical studies, it’s not clear whether chromium is effective and safe for treating type 2 diabetes. More studies are needed.

If you’re interested in taking cinnamon, chromium, or another natural alternative to help treat type 2 diabetes, talk with your doctor. They can discuss the pros and cons with you.

Will I have withdrawal symptoms if I stop taking Januvia?

It’s not likely. No withdrawal symptoms have been reported with Januvia.

If you want to stop taking Januvia, first talk with your doctor. They’ll let you know how to best stop your treatment. Your doctor will also recommend other ways to help manage your diabetes.

Will Januvia stop working to treat my blood sugar after a while?

It’s not likely. Januvia is meant to be taken long term, and the drug shouldn’t stop working. Januvia should help control your blood sugar for as long as you take it. However, not everyone’s body reacts in the same way. So while it’s unlikely, it’s possible that your body will stop responding to Januvia after a while.

In the case that Januvia no longer works for you, your blood sugar level may become high. This is called hyperglycemia and its symptoms include:

  • extreme thirst
  • urinating much more often than usual
  • urinating more often at night
  • fatigue (lack of energy)
  • sores that don’t heal
  • blurry vision

If you have any of these symptoms, tell your doctor right away. If the amount of sugar in your blood is too high, you may need a different medication than Januvia.

Januvia precautions

Januvia comes with several warnings.

Before taking Januvia, talk with your doctor about your health history. Januvia may not be right for you if you have certain medical conditions. These include:

Pancreatitis

Januvia may cause pancreatitis (swelling of the pancreas). If you’ve had pancreatitis in the past, it’s possible that taking Januvia may cause the condition to flare up. Other health issues can also cause your pancreas to swell or not work correctly. So before taking Januvia, tell your doctor if you’ve had any of the following:

  • pancreatitis
  • high levels of triglycerides (a type of fat in your blood)
  • gallstones (small, hard masses in your gallbladder)
  • a history of alcoholism

Symptoms of pancreatitis include severe pain in the area of your abdomen (belly) that doesn’t go away. This pain can spread to your back, and it may or may not cause you to vomit. If you notice these symptoms, tell your doctor right away. They’ll probably have you stop taking Januvia.

Kidney failure

Kidney problems may increase how much Januvia stays in your body. This can lead to complications, including pain or pressure in your chest or swelling of your legs, ankles, and feet. In rare cases, some people have reported kidney problems or kidney failure after taking Januvia.

Tell your doctor if you have or have had kidney problems. They’ll monitor how your kidneys are working during your Januvia treatment. Your doctor may also adjust the amount of Januvia that you take, if needed.

Heart failure

If you’ve had heart failure in the past, taking Januvia may increase your risk of developing the condition again. Heart failure occurs when your heart can’t pump enough blood to the rest of your body.

Before you start taking Januvia, tell your doctor if you’ve had heart failure. If you have, they’ll check your heartbeat while you take the drug. Your doctor will also monitor you for heart failure symptoms during your treatment. These include:

  • shortness of breath
  • swelling or fluid retention (buildup of fluid in your body)
  • rapid increase in weight
  • unusual tiredness

If you notice any of these heart failure symptoms yourself, tell your doctor right away. They’ll monitor your heartbeat and prescribe you with medications to help your heart to function properly.

Note: For more information about the potential negative effects of Januvia, see the “Januvia side effects” section above.


Januvia expiration, storage, and disposal

When you get Januvia from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date they dispensed the medication.

The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, ask your pharmacist whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Keep Januvia tablets at room temperature in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Disposal

If you no longer need to take Januvia and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Professional information for Januvia

The following information is provided for clinicians and other healthcare professionals.

Indications

Januvia is indicated for the treatment of type 2 diabetes. It is used as an adjunct in people who exercise and are under dietary control. Its use as a pharmacologic treatment can be either as monotherapy or in combination with other drugs.

Januvia isn’t approved by the FDA for the treatment of type 1 diabetes or diabetic ketoacidosis. Also, it hasn’t been studied in people with a clinical history of pancreatitis.

Mechanism of action

Januvia acts by inhibiting an enzyme known as dipeptidyl peptidase 4 (DPP-4). This enzyme is responsible for inactivating the biological effects of incretin hormones. The most common incretin hormones include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP).

Incretin hormones are released by the intestine. The hormones’ release increases during meals. The function of incretin hormones is to increase insulin synthesis and promote insulin release from pancreatic beta cells. Inactivation of these hormones by DPP-4 prevents them from functioning and promotes hyperglycemia. Januvia therefore increases the release of insulin by inhibiting DPP-4.

Also, GLP-1 acts on pancreatic alpha cells and reduces the levels of glucagon. By inactivating GLP-1, DPP-4 increases the levels of glucagon in blood. This causes excessive production of glucose by the liver. Januvia’s effect also prolongs the activity of GLP-1 and indirectly reduces the hepatic production of glucose.

Januvia doesn’t have an in vitro biological effect in inhibiting DPP-8 or DDP-9.

Pharmacokinetics and metabolism

A single dose of 100 mg of Januvia reaches peak concentration within one to four hours following its administration. The maximum concentration it reaches is 950 nM, with a half-life of 12.4 hours. It has an area under the curve (AUC) of 8.52 M.hr. AUC increases proportionally to dose increases. A 14% increase in AUC is observed following 100 mg after the initial dose.

Januvia has an absolute bioavailability of 87% and is 38% plasma protein bound.

Januvia is mostly eliminated unchanged through the kidney. Seventy-nine percent of the drug leaves the body unchanged via the urine. Januvia undergoes limited metabolism overall, with contributions from CYP3A4 and CYP2C8.

Januvia is a substrate of P-glycoprotein, but its clearance is not substantially impacted by administration of P-gp inhibitors.

The pharmacokinetics of Januvia is altered in people with moderate renal impairment (estimated glomerular filtration rate [eGFR] between 30 to 45 mL/min/1.73m2). These people have a twofold increase in the AUC. The AUC can increase up to fourfold in people with severe renal impairment.

The pharmacokinetics of Januvia is also affected in people with moderate hepatic impairment (Child-Pugh score between 7 and 9). These people have AUC and mean peak drug concentration (Cmax) increases of 21% and 13%, respectively. These changes are not thought to be clinically significant and do not necessitate dosage adjustment.

Contraindications

Januvia is contraindicated in people with a history of hypersensitivity reaction to sitagliptin. If a hypersensitivity reaction is observed or suspected, treatment should be discontinued.

Hypersensitivity reactions have been observed within three months after the first dose of Januvia. These reactions may include:

  • anaphylaxis
  • angioedema
  • exfoliative skin condition (including Stevens-Johnson syndrome)

Angioedema has also been observed in people taking other DPP-4 inhibitors. Pay special attention in people with a history of angioedema with another DPP-4. They may have a predisposition to hypersensitivity reactions.

Storage

Januvia should be stored between 68°F to 77°F (20°C to 25°C).

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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