Januvia for Type 2 Diabetes | Uses, Side Effects & Risks

What is Januvia?

Januvia is a brand medication used to treat type 2 diabetes mellitus. It is also known by its generic name, sitagliptin. Januvia is prescribed when lifestyle changes, like diet and exercise, are not enough to control your diabetes. It can be taken alone or in combination with other medications. It's important to note that Januvia is specifically designed for type 2 diabetes and should not be used for type 1 diabetes. Unlike some other diabetes medications, Januvia is considered "weight neutral," meaning it should not cause weight loss or gain.

How Januvia Works For Type 2 Diabetes

Januvia belongs to the class of medications known as “dipeptidyl peptidase-4 inhibitors” (DPP-4s) and works by inhibiting an enzyme called dipeptidyl peptidase-4 (DPP-4). This enzyme breaks down incretin hormones, such as GLP-1 (glucagon-like peptide-1), which help regulate insulin production and release.

By inhibiting DPP-4, Januvia increases the levels of incretin hormones in the body. This, in turn, stimulates the pancreas to release more insulin when blood sugar levels are high (after a meal), and it also reduces the production of glucose by the liver. As a result, Januvia helps lower blood sugar levels after meals and throughout the day.

Since DPP-4 inhibitors work on the same pathway ad GLP-1, they should not be used alongside GLP-1 agonist medications, such as Ozempic and Rybelsus.

Starting Dose

The typical starting dose of Januvia for most adults with type 2 diabetes is 100 mg taken orally once daily. This dosage is often effective in controlling blood sugar levels. However, your healthcare provider may adjust the starting dose based on your specific medical condition, kidney function, and other factors.

Typical Side Effects of Januvia

Since medications make changes to the body, they sometime have unwanted side effects. Side effects are relatively uncommon with this medication, though it is important to be aware of these risks.

The most common side effects of Januvia include:

• Low blood sugar

  Taking Januvia at the same time as insulin or sulfonylureas (ie: Jardiance) may increase your risk of low blood sugar

• Headache
• Nausea
• Constipation
• Diarrhea
• Pancreatitis*

  *Pancreatitis (inflammation of the pancreas – the organ that makes insulin and glucagon) is a rare side effect that can occur with Januvia. If you experience signs of pancreatitis (upper abdominal pain, fever, nausea, abdominal tenderness) it is important to seek medical attention.

Interactions

Certain medications can interacti with Januvia (sitagliptin) and affect effectiveness or increase the risk of side effects. Here are some examples of medications that may interact with Januvia:

• Sulfonylureas: Drugs such as glimepiride and glipizide, which are used to stimulate insulin release, may interact with Januvia. Combining Januvia with these medications can increase the risk of hypoglycemia (low blood sugar). Your healthcare provider may need to adjust the dosage of both Januvia and the sulfonylurea to prevent low blood sugar levels.
• Insulin: Januvia can be used in combination with insulin therapy for better blood sugar control. However, it is important to monitor your blood sugar levels closely and adjust your insulin dosage as necessary when initiating or changing the dose of Januvia.
• Drugs Affecting Kidney Function: Medications that impact kidney function can affect the clearance of Januvia from the body. Examples include certain antibiotics (e.g., trimethoprim/sulfamethoxazole) and drugs used to treat HIV (e.g., ritonavir). Your healthcare provider may need to adjust the dose of Januvia based on your kidney function or consider alternative medications.
• Other Oral Diabetes Medications: Some oral antidiabetic medications, such as thiazolidinediones (TZDs) and meglitinides, may interact with Januvia. Your healthcare provider will consider potential drug interactions when determining the appropriate treatment plan.

Can I Use Januvia If I Have Kidney Failure?

Yes, Januvia is safe at all levels of kidney failure including during dialysis. However, since this medication is cleared from the body through the kidneys, with decreased kidney function, the dosage of Januvia may have to be decreased.