Other drugs, alcohol, and more

Januvia (sitagliptin) is a brand-name prescription drug. It’s used to help manage blood sugar levels in adults with type 2 diabetes. As with other medications, Januvia can interact with certain other drugs and some supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Januvia’s interactions, keep reading. For additional information about Januvia, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Januvia due to the risk of harm. These are known as contraindications. The contraindications of Januvia include:

Having had an allergic reaction to Januvia or any of its ingredients

If you’ve had an allergic reaction to Januvia or any of its ingredients, your doctor will likely not prescribe Januvia. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Januvia, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Januvia.

Januvia isn’t known to interact with alcohol.

However, it may be best to limit the amount of alcohol you consume while taking the drug. This is because alcohol may affect blood sugar levels. Januvia is used to help manage blood sugar levels in adults with type 2 diabetes. So, drinking alcohol while taking Januvia could make it hard to tell if the drug is working to treat your condition.

If you consume alcohol, talk with your doctor. They can tell you whether there’s a safe amount to drink while taking Januvia.

Before you start treatment with Januvia, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

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

Here’s a chart of drugs that can interact with Januvia. Keep in mind that this chart does not include all drugs that may interact with Januvia. Some of these interactions are described in detail just below in ‘Drug interactions in depth.’

Here’s a closer look at certain drug interactions of Januvia.

Sulfonylureas

Sulfonylureas area a type of diabetes drug. Like Januvia, they’re used to help manage blood sugar levels in people with type 2 diabetes.

Interaction result. Taking Januvia in combination with a sulfonylurea can increase the risk of low blood sugar with either drug.

Interaction explained. Both Januvia and sulfonylureas can lower blood sugar when taken individually. Taking Januvia and a sulfonylurea together may lower your blood sugar further.

Examples of sulfonylurea drugs. Below are some examples of sulfonylureas that may interact with Januvia:

• glipizide (Glucotrol XL)
• glyburide (Diabeta, Glynase)
• glimepiride (Amaryl)

Steps you or your doctor may take. If you take Januvia with a sulfonylurea, your doctor may recommend a lower dosage of a sulfonylurea than is usually prescribed. Doing so should help reduce your risk of decreased blood sugar when these medications are taken together.

While taking Januvia with a sulfonylurea, watch for symptoms of low blood sugar. Examples include dizziness, headache, shaking, and sweating.

If you have these symptoms, you should eat at least 15 grams (g) of carbohydrates or sugar. Examples of sources of sugar include hard candies, glucose tablets, and fruit juice. Keep in mind that diet or sugar-free candy or soda will not treat low blood sugar.

In severe cases, low blood sugar may cause seizures or loss of consciousness. If you have symptoms of low blood sugar that seem severe or life threatening, 911 or the local emergency number should be called right away. Or someone should get you emergency medical treatment immediately.

Insulin

Insulin is used to help manage blood sugar levels in people with diabetes.

Interaction result. Taking Januvia in combination with insulin can increase the risk of low blood sugar with either medication.

Interaction explained. Both Januvia and insulin can lower blood sugar when used individually. Taking Januvia and insulin together may cause greater decreases in your blood sugar level.

Examples of insulins. Here are some insulins that may interact with Januvia:

• insulin degludec (Tresiba)
• insulin glargine (Lantus, Toujeo)
• insulin detemir (Levemir)
• insulin lispro (Humalog)
• insulin aspart (NovoLog)

Steps you or your doctor may take. If your doctor prescribes Januvia with insulin, they may recommend a lower dosage of insulin than usual. This should help decrease the risk of low blood sugar when these medications are used together.

While taking Januvia with insulin, watch for symptoms of low blood sugar. Examples include: shaking, dizziness, sweating, and headache.

If you have symptoms of low blood sugar, it’s important to eat at least 15 g of sugar or carbohydrates. Sources of sugar include fruit juice, hard candies, and glucose tablets. Keep in mind that diet or sugar-free candy or soda will not treat low blood sugar.

If your blood sugar becomes severely low, you may have seizures or lose consciousness. If you have symptoms of low blood sugar that seem severe or life threatening, 911 or the local emergency number should be called right away. Or someone should get you emergency medical treatment immediately.

Oral birth control

Oral birth control refers to medications that are taken by mouth to help prevent pregnancy.

Interaction result. Oral birth control can make Januvia less effective than usual.

Interaction explained. The hormones in birth control pills can increase your blood sugar level. This can make it more difficult for Januvia to help manage your blood sugar level.

Examples of oral birth control. Below are examples of oral birth control drugs that may interact with Januvia:

• ethinyl estradiol/norgestimate (Estarylla, Sprintec, others)
• drospirenone/estetrol (Nextstellis)
• ethinyl estradiol/norethindrone (Aranelle, Gildagia, others)

Steps you or your doctor may take. Before starting Januvia treatment, tell your doctor if you take any oral birth control pills. They can recommend whether it’s safe for you to take these medications together.

Januvia may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Januvia.

Januvia interactions with supplements

Garlic supplements may interact with Januvia. These supplements have been reported to lower blood sugar in some people with type 2 diabetes. (Januvia is also used to treat this condition.)

Taking garlic supplements with Januvia could increase your risk of low blood sugar. Your doctor can advise you on whether it’s safe to take Januvia with garlic supplements.

If your doctor approves you taking Januvia with a garlic supplement, they may have you check your blood sugar levels often. This way, you can monitor whether your they might be dropping too much. You should also watch for symptoms of low blood sugar. To learn about possible symptoms, see ‘Sulfonylureas’ in ‘Drug interactions in depth’ above.

Before you start treatment with Januvia, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

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

Januvia and herbs

There are no specific reports of herbs interacting with Januvia. However, it’s possible that some herbs might affect blood sugar levels. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Januvia treatment.

Januvia and vitamins

Vitamins have not been reported to interact with Januvia. However, it’s possible that interactions with vitamins could be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Januvia.

Januvia and food

Although garlic supplements* may interact with Januvia, there were no reports of food interactions with the drug.

The amount of garlic in foods or seasonings is typically much less than what’s in a garlic supplement. This small amount of garlic is not likely to affect blood sugar. So, it should be safe to eat foods or seasonings containing garlic during Januvia treatment.

If you have additional questions or want more information about eating certain foods while taking Januvia, talk with your doctor.

* To learn more, see ‘Januvia interactions with supplements’ above.

Januvia and vaccines

Januvia and vaccines have not been reported to interact with each other. For more information about getting certain vaccines while taking Januvia, talk with your doctor or pharmacist.

Januvia and lab tests

No lab tests have been reported to interact with Januvia. Your doctor or pharmacist can tell you more about having certain lab tests during Januvia treatment.

Januvia and cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Januvia. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Januvia. The impact of cannabis may affect how well you stick to your Januvia treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Januvia. Before you take Januvia, be sure to talk with your doctor about your health history. Januvia may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Januvia include the following.

Allergic reaction. If you’ve had an allergic reaction to Januvia or any of its ingredients, your doctor will likely not prescribe Januvia. To learn more, see ‘When to avoid Januvia’ above.

Kidney problems. If you have kidney problems, such as kidney failure, be sure to tell your doctor before taking Januvia. Having kidney problems may increase your risk of side effects with Januvia, including heart failure. Your doctor can recommend whether it’s safe to take Januvia. If they prescribe Januvia, they may give you a lower dosage of the drug than usual.

Pancreatitis. Januvia may cause pancreatitis. The drug hasn’t been studied in people who have had pancreatitis in the past. So, it isn’t known whether having had this condition could increase the risk of pancreatitis with Januvia. If you’ve had pancreatitis, your doctor can recommend whether it’s safe for you to take Januvia.

Heart failure. Januvia may cause heart failure. If you already have heart failure, the drug may worsen your condition. In this case, your doctor can advise you on whether it’s safe to take Januvia.

If your doctor prescribes Januvia, they’ll recommend watching for symptoms of worsened heart failure while you’re taking the drug. Examples of these symptoms include rapid weight gain, trouble breathing, and swelling in your legs, ankles, or feet. Your doctor will also monitor you for these side effects. If you develop worsening heart failure with Januvia, your doctor can instruct you on how to manage it.

Pregnancy. It’s not known whether Januvia is safe to use while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before you take the medication. For details about Januvia’s use during pregnancy, see this article.

Breastfeeding. Januvia passes into breast milk during breastfeeding, which could cause side effects in a breastfed child. If you’re breastfeeding, talk with your doctor before using Januvia. To learn more about Januvia’s use while breastfeeding, see this article.

Here are some frequently asked questions about Januvia and possible interactions.

Has Januvia been recalled due to any interactions?

No, Januvia has not been recalled due to any interactions.

A drug recall occurs when a medication is no longer available because it has been removed from the market. This typically happens because of a safety issue. For example, the drug may accidentally contain an unwanted ingredient.

Januvia has not been recalled because of any safety issues, including any of its possible drug interactions.

If you have additional questions about Januvia, talk with your doctor or pharmacist.

Does Januvia interact with other diabetes drugs, such as Ozempic, Trulicity, Farxiga, or Jardiance?

Januvia is known to interact with certain diabetes drugs. However, Januvia is not known to interact with any of the following diabetes medications:

• semaglutide (Ozempic)
• dulaglutide (Trulicity)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)

Diabetes drugs that Januvia does interact with include sulfonylureas, meglitinides, and insulin. To learn more, see the ‘Drug interactions in depth’ section above.

Januvia is used to help manage blood sugar levels in adults with type 2 diabetes. Your doctor may prescribe Januvia alone or in combination with other diabetes medications. They can tell you more about taking Januvia with the diabetes drugs mentioned above.

Can I take Januvia with metformin?

Yes, you can take Januvia with metformin (Riomet, Fortamet, Glumetza). Januvia and metformin are not known to interact with each other.

In fact, Januvia is often prescribed in combination with metformin. Both drugs are used to help manage blood sugar levels in people with type 2 diabetes. Sitagliptin (the active drug in Januvia) is available in combination with metformin under the brand names Janumet and Janumet XR.

To learn more about taking Januvia with metformin, talk with your doctor.

You can take certain steps to help prevent interactions with Januvia. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Januvia label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Januvia doesn’t come with paperwork, ask your pharmacist to print a copy.) Your doctor and pharmacist can help answer any questions you have.

You can also help prevent interactions with Januvia by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Januvia. These resources might help:

• Overview of Januvia. For a general overview of Januvia, you can see this article.
• Side effects. If you’re interested in the side effects of Januvia, see this article. Another option is to refer to the Januvia prescribing information.
• Dosage specifics. To learn about the dosage of Januvia, see this article.
• Drug comparison. Learn how Januvia compares with Tradjenta and with metformin.
• Facts about diabetes. To learn more about your condition, see our diabetes hub.

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 another 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.

Januvia and Alcohol/Food Interactions – Drugs.com

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There is 1 alcohol/food/lifestyle interaction with Januvia (sitagliptin).

Alcohol may affect blood glucose levels in patients with diabetes. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may occur, depending on how much and how often you drink. You should avoid using alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or pancreatitis. Moderate alcohol consumption generally does not affect blood glucose levels if your diabetes is under control. However, it may be best to limit alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with your normal meal plan. Avoid drinking alcohol on an empty stomach or following exercise, as it may increase the risk of hypoglycemia. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Januvia drug interactions

There are 284 drug interactions with Januvia (sitagliptin).

Januvia disease interactions

There are 2 disease interactions with Januvia (sitagliptin) which include:

• pancreatitis
• renal dysfunction

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• Diabetes, Type 2

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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what you need to know – Drink-Drink

Introduction

If you have type 2 diabetes, your doctor may suggest Januvia (sitagliptin) as a treatment option. Along with other questions you may have about a drug, you may be interested in its side effects.

Januvia is a prescription drug. It is used with diet and exercise to help control blood sugar levels in adults with type 2 diabetes.

Januvia is available as tablets to be taken orally. Usually used as a long term treatment. For more information on Januvia see this detailed article on the drug.

Like all medicines, Januvia can cause mild or serious side effects. Keep reading to find out more.

What are the most common side effects of Januvia?

Some people may experience mild or severe side effects during treatment with Januvia. Examples of the most commonly reported side effects of Januvia include:

• Headache*
• sore throat
• stuffy or runny nose
• upper respiratory infections such as the common cold

Continue reading to learn about other possible minor and serious side effects of Januvia.

What are the mild side effects of Januvia?

Some people may experience mild side effects when taking Januvia.

Examples of mild side effects reported with Januvia include:

• Headache*
• sore throat
• stuffy or runny nose
• upper respiratory infections such as the common cold

In most cases, these side effects should be temporary. And some are easy to deal with. But if you have any symptoms that continue or bother you, talk to your doctor or pharmacist. And don’t stop using Januvia unless your doctor tells you to.

Januvia may cause mild side effects other than those listed above. See the Januvia Medication Guide for details.

After the Food and Drug Administration (FDA) approves a drug, it monitors and analyzes the drug’s side effects. If you would like to notify the FDA of a side effect you had with Januvia, visit MedWatch.

What are the serious side effects of Januvia?

In rare cases, serious side effects may occur when using Januvia.

Serious side effects reported with Januvia include:

• low blood sugar*
• skin reactions*
• heart failure
• pancreatitis (swelling of the pancreas)
• severe joint pain
• severe kidney problems such as acute acute (sudden) kidney failure
• allergic reaction*†

If you develop serious side effects while taking Januvia, contact your doctor immediately. If the side effects seem life-threatening or if you think you need emergency medical attention, call 9 right away11 or your local emergency number.

Januvia Side Effects Frequently Asked Questions

Get answers to some frequently asked questions about Januvia side effects.

Can Januvia cause weight loss or weight gain?

Possibly. Weight loss and weight gain were not reported as side effects in studies of the drug.

Some people who took Januvia in these studies did experience weight gain and weight loss. But it is unclear whether Januvia herself caused these weight changes.

Be aware that rapid weight gain may be a sign of heart failure, which is a possible serious side effect of Januvia. Tell your doctor right away if you notice a sudden weight gain.

If you are concerned about weight gain while taking Januvia, talk to your doctor. They can suggest healthy ways to manage your weight.

Are there any reviews from people who have used Januvia?

No, the drug manufacturer did not provide feedback from people who took Januvia.

If you have questions about what to expect from Januvia treatment, talk to your doctor or pharmacist.

Will the risk of side effects change depending on the dose of Januvia I take (25mg, 50mg or 100mg)?

Possibly, but not sure. Januvia’s studies did not consider the side effects of the drug depending on the strength of the action.

Your doctor can tell you more about the risk of side effects from the Januvia strength they have prescribed.

Does Januvia cause yeast infections?

This is unlikely. The Januvia studies did not report yeast infections as a side effect.

But the diabetes that Januvia is used to treat can cause a yeast infection. Therefore, it is possible that you may have a yeast infection while taking Januvia. But the infection is most likely the result of the condition you are using Januvia to treat, not the drug itself.

If you have any questions about the risk of yeast infections while taking Januvia, talk to your doctor.

What are some of the long term side effects of Januvia?

Januvia may cause certain long-term side effects.

For example, with Januvia, heart failure can occur. And if heart failure worsens over time, the condition can lead to long-term problems. Examples of the long-term consequences of heart failure include irregular heartbeats, blood clots, and stroke.

If you are concerned about the long-term side effects of Januvia, talk to your doctor. They may suggest ways to reduce the risk of these side effects. They may also recommend ways to manage these side effects if you experience them.

Warnings for Januvia

Januvia may not be right for you if you have certain medical conditions or other factors affecting your health. Talk to your doctor about your medical history before taking Januvia.

Conditions or factors that prevent taking a medicine are sometimes called contraindications.

The list below includes factors to consider before taking Januvia.

Heart failure. Januvia may cause new or worsening heart failure. Before starting treatment with Januvia, be sure to tell your doctor if you have heart failure. You may be prescribed another drug besides Januvia.

Kidney problems. Tell your doctor if you have any kidney problems before you start taking Januvia. In rare cases, taking Januvia can cause serious kidney problems, such as acute (sudden) kidney failure. You may be at a higher risk of this side effect if you already had kidney problems before taking Januvia. If you have kidney problems, your doctor may prescribe a lower dose than usual for you.

Pancreatitis. In rare cases, Januvia may cause pancreatitis (swelling of the pancreas). If you have a history of this condition, tell your doctor before you start taking Januvia. It is possible that you may be at a higher risk of this side effect if you have had pancreatitis in the past. Your doctor will advise if it is safe for you to use Januvia.

Allergic reaction. If you have had an allergic reaction to Januvia or any of its ingredients, you should not take Januvia. Ask your doctor which other medicines are best for you.

Alcohol use and Januvia

There are no known safety issues with alcohol when taking Januvia.

However, alcohol can affect blood sugar levels. If you have diabetes, this can make it difficult to control your blood sugar.

Januvia is used to control blood sugar levels in people with type 2 diabetes. Drinking alcohol while taking Januvia may affect your blood sugar levels. Therefore, you may need to limit the amount of alcohol you drink while taking the drug.

If you drink alcohol, talk to your doctor about the safe amount of alcohol you can drink while taking Januvia.

Pregnancy and breastfeeding while taking Januvia

It may not be safe to take Januvia while pregnant or breastfeeding.

If you are taking Januvia while pregnant, consider registering with the Januvia Pregnancy Registry. This registry contains important information about the effects of Januvia when taken during pregnancy. This information may help researchers understand the risks and benefits of using the drug during pregnancy.

To register with the Januvia Pregnancy Registry, call 800-986-8999. You can also talk to your doctor about registration options.

If you are pregnant or breastfeeding, plan to breastfeed or become pregnant while taking Januvia, talk to your doctor. They can tell you about the risks and benefits of taking the drug at this time.

Side effects explained

Find out more about some of the side effects Januvia may cause.

Low blood sugar

Low blood sugar is a common side effect of Januvia.

You may be at a higher risk of low blood sugar if you take Januvia in combination with certain diabetes medicines, including insulins and sulfonylureas. Glucotrol (glipizide) and Diabeta (glyburide) are examples of sulfonylurea.

Below are a few possible symptoms of low blood sugar:

• Headache
• dizziness
• confusion
• feeling nervous or irritable
• increased heart rate
• drowsiness
• sweating

9 0025

What can help

If you are experiencing symptoms of low blood sugar, try raising your blood sugar by eating 15 grams of carbohydrates. Good sources for this purpose include glucose tablets, 4 ounces of juice or soda (but not diet soda), and hard candies. After 15 minutes, check your blood sugar and take another 15 grams of carbohydrates if needed.

Also tell your doctor right away if you have symptoms of low blood sugar while taking Januvia. They may need to adjust the dosage of other diabetes medications you are taking.

Skin reactions

Skin reactions are a rare but possibly serious side effect of Januvia. In particular, Januvia can cause bullous pemphigoid. This is a type of severe skin reaction that may require hospital treatment.

Bullous pemphigoid causes blistering of the skin, usually around the joints of the arms and legs. Blisters may also appear in the lower abdomen.

What can help

Tell your doctor if you experience any skin reactions while taking Januvia. They will most likely force you to stop taking the drug. They will also let you know if you need to go to the hospital to treat your condition. Or they may recommend that you see another health care professional, such as a dermatologist.

Headache

Headache is a common side effect of Januvia.

Be aware that a headache may be a sign of low blood sugar. This is another possible side effect of Januvia. See the “Low Blood Sugar” section above for more information.

What can help

Tell your doctor if you get headaches while taking Januvia. They may ask if you have any other symptoms of low blood sugar. If necessary, they will make adjustments to your treatment plan to help raise your blood sugar levels. This may ease your headache.

If your headaches are not related to low blood sugar, your doctor can suggest ways to manage this side effect. For example, they may recommend Tylenol (acetaminophen) or Advil (ibuprofen) for headache relief.

But don’t take new Januvia medicines until you talk to your doctor or pharmacist. Before you start taking new medications, they will make sure that these drugs do not interact with Januvia and make any side effects of Januvia worse.

Allergic reaction

Like most medicines, Januvia may cause an allergic reaction in some people. This side effect has not been reported in studies. But ever since the drug was on the market, allergic reactions to Januvia have been reported.

Symptoms may be mild or severe and may include:

• skin rash
• itching
• redness (temporary warmth, redness, or increased skin color)
• swelling under the skin, usually on the eyelids, lips, arms, or legs
• swelling of the mouth, tongue, or throat that makes breathing difficult

What can help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. To manage your symptoms, they may suggest an over-the-counter antihistamine you take by mouth, such as Benadryl (diphenhydramine). Or they may recommend a product you apply to your skin, such as a hydrocortisone cream.

If your doctor confirms that you had a mild allergic reaction to Januvia, they will decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms can be life threatening and require immediate medical attention.

If your doctor confirms that you have had a severe allergic reaction to Januvia, he may ask you to switch to another treatment.

Tracking side effects

While on Januvia, consider keeping a record of any side effects you experience. You can then share this information with your doctor. This is especially helpful when you first start taking new medications or using a combination of treatments.

Your side effect notes may include things like:

• what dose of the drug you were taking when you had the side effect
• How soon after starting this dose did you experience a side effect
• What were your symptoms due to the side effect
• How did it affect your daily activities
• What other medications did you also take
• Any other information you think is important

Keeping records and sharing them with your doctor will help him learn more about how Januvia affects you. And your doctor can use this information to adjust your treatment plan if necessary.

What to ask your doctor

Januvia is used to treat type 2 diabetes. Some people may experience mild side effects while taking the drug. In rare cases, others may experience serious side effects such as heart failure.

If you have any questions about the side effects of Januvia, talk to your doctor or pharmacist. Below are some examples of questions you might want to ask:

• Is muscle pain or hair loss a side effect of Januvia?
• How can I control my weight while taking Januvia?
• How much alcohol is safe for me when taking Januvia?
• Am I at higher risk of Januvia side effects?

For advice on managing your condition and more, subscribe to our Type 2 Diabetes Newsletter online.

Ask a pharmacist

Q:

Are there any health conditions that may increase the risk of pancreatitis as a side effect of Januvia?

Anonymous

A:

It is possible that certain health conditions may increase the risk of pancreatitis during treatment with Januvia. Examples include gallstones, kidney problems, high levels of triglycerides (a type of fat) in the blood, and a history of alcohol abuse. Before you start taking Januvia, tell your doctor if you have ever had these conditions. They may recommend a different drug to treat type 2 diabetes.

Melissa Badowski, PharmD, MPH, FCCP Answers represent the views of our medical experts. All content is for informational purposes only and should not be considered medical advice.

Registration data: Drink-Drink has made every effort to ensure that all information is accurate, complete and up to date. However, this article should not be used as a substitute for the knowledge and experience of a licensed healthcare professional. You should always check with 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 side effects. The absence of warnings or other information for a given medicinal product does not mean that the drug or combination of drugs is safe, effective, or suitable for all patients or for all specific uses.

increased adherence to treatment of patients with type 2 diabetes uMEDp

Type 2 diabetes in terms of prevalence and development of severe complications is a threat to life no less than AIDS/HIV infection. Diabetes mellitus is the leading pathology according to the most formidable and most frequent complications, which we named SAGA (Blindness, Amputations, Hemodialysis, Coronary Artery Bypass Surgery). Their development can be prevented by optimal glycemic control. Only the appointment of effective hypoglycemic drugs is not enough, it is also necessary to achieve high adherence of patients to treatment. This can be increased by reducing the frequency of taking medications.
The article discusses the possibilities of a fixed combination of slow-release metformin and the dipeptidyl peptidase 4 inhibitor sitagliptin in terms of increasing not only the effectiveness of therapy, but also adherence to it.

Fig. 1. Influence of the frequency of taking the drug on the adherence of patients to treatment

Fig. 2. Adherence to treatment when switching from Metformin BV to Metformin MB

Fig. 3. Patient adherence to treatment before and after switching to Metformin MB

Fig. 4. Features of the pharmacokinetics of metformin BV and metformin MV

Fig. 5. Decrease in mean HbA1c over six months of follow-up

The scale of the spread of diabetes mellitus (DM), associated cardiovascular complications, including fatal ones, damage to organs and systems, disorders of all types of metabolism, allow us to consider it a threat to humanity.

According to the International Diabetes Federation (IDF), as of January 1, 2015, there were 415 million patients with diabetes, with an annual increase of 9.5 million. By 2040, the incidence is expected to increase by 55% and the number of people with diabetes can reach 642 million [1]. Based on the analysis of IDF experts’ forecasts for previous decades, it can be assumed that the latest forecast is also optimistic. By this year, the number of diabetics will exceed 750 million.

In Russia, according to the results of the NATION study, 5.4% of the population aged 20 to 79 years, which is approximately 6 million people, suffer from type 2 diabetes, 19.26% are in a state of prediabetes [2].

Considering the abrupt increase in the incidence rate, it is possible to predict an increase in the total healthcare costs [3] for the treatment of not only DM, but also its complications. The most frequent and formidable of them are blindness, amputation, hemodialysis, coronary artery bypass grafting – SAGA for short.

The main reason for the development of complications of type 2 diabetes is chronic hyperglycemia.

With the manifestation of type 2 diabetes, insulin secretion decreases by almost 50%, sensitivity to it – by 70% [4]. Insulin resistance leads to a decrease in glycogen synthesis, activation of glycogenolysis and gluconeogenesis. Stress, infections, reduced physical activity, old age, alcohol intake, obesity, and other conditions also contribute to the development of insulin resistance [5].

Long-term insulin resistance is compensated by non-physiological hyperinsulinemia. In the future, this mechanism is lost, and the production of glucose by the liver increases. As a result, an increase in fasting glycemia. In type 2 diabetes, despite the food load, the production of endogenous glucose by the liver continues, which, combined with a relative lack of insulin release, leads to postprandial hyperglycemia.

At the stage of establishing the diagnosis of type 2 diabetes, the main therapeutic measures are lifestyle modification and the appointment of metformin as a first-line drug (in the absence of contraindications).

Metformin is the only biguanide drug approved for use [6]. It contributes to insulin-induced suppression of gluconeogenesis from lactate, pyruvate, glycerol, some amino acids and prevents the gluconeogenetic action of glucagon [7]. Nocturnal production of glucose by the liver is suppressed, as a result, fasting glycemia decreases. For adequate glycemic control, in addition to the target values ​​of fasting glycemia, it is necessary to achieve the target values ​​of postprandial glycemia. If the control of postprandial glucose levels is not associated with an increase in the risk of hypoglycemic conditions, then the control of fasting plasma glucose values, on the contrary, is associated with it [8].

After the discovery of incretins (glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)) – endogenous stimulators of insulin secretion in response to food intake, drugs have been developed that regulate glycemia by modulating GLP-1 secretion. The latter stimulates glucose-dependent release of insulin, suppresses the production of glucagon, slows down the evacuation of food from the stomach, reduces appetite and may help preserve the function of beta cells in patients with type 2 diabetes [9].

Inhibition of dipeptidyl peptidase 4 (DPP-4) slows down the degradation of endogenous GLP-1. As a result, the action of the insulinotropic hormone is enhanced and prolonged [10].

The identification of the physiological role of incretins (GLP-1 and GIP) in the regulation of carbohydrate metabolism made it possible to consider them as therapeutic targets [11].

It has now been proven that for successful management of type 2 diabetes, including at the start of therapy, it is necessary to combine antihyperglycemic drugs that would complement each other’s action. At the same time, it was found that the simultaneous use of several drugs makes it difficult to comply with the prescribed regimen. Non-compliance with the drug regimen in combination therapy is due to the need to take a large number of tablets (Fig. 1), as well as the development of side effects. This leads to a decrease in adherence to treatment or its cancellation, suboptimal clinical results.

The results of a study conducted by A.H. Paes et al. (1997) [12], showed that when prescribing the drug twice a day, the adherence of patients to treatment is 66%.

It has been established that adherence to therapy with oral hypoglycemic drugs (PSBP) varies from 30 to 90% [13, 14]. Low adherence to therapy (study participants received PSSP, statins, and antihypertensive drugs) increased the incidence of adverse outcomes in patients with type 2 diabetes. Overall mortality in the high adherence group (n = 9076) was 4%, with low (n = 2456) – 5.9% (p

Y. Rozenfeld et al. (2008) found that adherence to treatment with PSP is inversely proportional to the level of HbA1c [14]. Thus, an increase in adherence to therapy by 10% leads to a decrease in HbA1c values ​​by 0.1% (p = 0.0004).

One of the possible ways to solve the problem of low adherence to treatment may be the use of fixed combinations of PSSP. This, in turn, will lead to a more pronounced clinical effect (Fig. 2 and 3).

The first meta-analysis comparing the effectiveness of glycemic control when using fixed and free combinations was performed on the results of ten clinical studies involving 70,573 patients with type 2 diabetes. The use of the fixed combination was associated with lower HbA1c levels. The average difference for this indicator between groups was -0.53% (95% confidence interval -0.78–-0.28, р

What groups of drugs can be combined?

A number of clinical studies have examined the advantages and disadvantages of biguanides, sulfonylurea derivatives, thiazolidinediones, and insulin. The possibility of combining drugs of the last three groups is limited due to the risk of weight gain (sulfonylurea derivatives, thiazolidinediones and insulin), hypoglycemia (sulfonylurea derivatives and insulin), depletion of beta cells (sulfonylurea derivatives) [16]. Combination with GLP-1 receptor agonists and DPP-4 inhibitors may be preferred. Both groups of drugs increase the concentration of GLP-1 and thus affect many pathogenetic mechanisms of type 2 diabetes [17].

When should combination therapy be given?

Considering the complex pathogenesis of type 2 diabetes, two-component hypoglycemic therapy is indicated for patients with an HbA1c level of more than 7. 6%.

Metformin

Metformin is an insulin sensitizer to a greater extent in the liver and to a lesser extent in muscle and adipose tissues [18]. As mentioned above, its action is mainly aimed at inhibiting gluconeogenesis in the liver [19]. Metformin is able to reduce the absorption of glucose in the intestine and increase endogenous levels of GLP-1 [20], which leads to a decrease in postprandial glycemia.

The molecular mechanism of metformin is not fully understood. To date, it has been established that it affects cell membranes, affects the oxidation of the respiratory chain and the activation of adenosine monophosphate-dependent protein kinase [18].

An increase in the sensitivity of peripheral tissues to insulin under the influence of metformin is realized through a number of cellular mechanisms. The number and affinity of insulin receptors increase. There is a stimulation of the tyrosine kinase activity of insulin receptors, as well as the expression and activity of glucose transporters, their translocation from the intracellular pool to the cell membrane. As a result, glucose uptake by insulin target organs (liver, muscle and adipose tissue) increases, and glycogen synthesis in the liver increases.

Metformin is also able to influence fat metabolism [21]. An increase in the concentration of free fatty acids is observed in most patients with type 2 diabetes. Against the background of metformin, the oxidation of free fatty acids decreases by 10–30%, which leads to an improvement in tissue sensitivity to insulin and correction of its secretion [22].

Standard fast-release metformin (RMB) requires twice daily dosing. Such therapy may be poorly tolerated due to the development of adverse effects on the part of the gastrointestinal tract (GIT). Metformin slow release (MB), or long, is taken once a day, therefore it is characterized by a lower frequency of adverse reactions from the gastrointestinal tract. The pharmacokinetics of two forms of metformin is shown in Fig. 4.

In a cohort study lasting 52 weeks, 310 records of patients treated with metformin MB and 158 records of patients treated with metformin BV were analyzed [23]. Both groups included patients who took the indicated drug as the first line for no more than two years before the start of the study.

Previous experience of side effects with the use of metformin BV did not prevent the inclusion of patients in the study. However, patients with serious gastrointestinal diseases, moderate or severe hepatic or renal insufficiency were excluded from it.

The primary end points were the overall incidence of gastrointestinal adverse events and the incidence of diarrhea.

205 patients were transferred from metformin BV to metformin MV. The overall frequency of gastrointestinal adverse reactions with metformin BV was 26.34%, after switching to metformin MB – 11.71%. The incidence of diarrhea decreased from 18.05% to 8.29%. There was no statistically significant difference in daily doses of drugs in both groups.

Another study included 253 Caucasian patients with type 2 diabetes who did not reach the target HbA1c (> 7. 0 and

Body weight, HbA1c levels, fasting and postprandial plasma glucose, fasting plasma insulin (FPI), insulin resistance index (HOMA-IR), lipid profile, values ​​of individual adipocytokines (tumor necrosis factor alpha (TNF-alpha), highly sensitive C-reactive protein (CRP), visfatin, vaspin), as well as satisfaction with treatment were assessed.

Six months later, both groups showed a comparable decrease in body weight and body mass index, however, indicators of glycemic control, HOMA-IR in the metformin MB group were significantly better. In the metformin MB group, a significant decrease in total cholesterol and low-density lipoprotein values ​​was also recorded. In addition, those taking metformin MB had reduced levels of TNF-alpha, CRP, vaspin, and increased levels of visfatin.

The results of pharmacoeconomic analysis show that from the point of view of efficiency and safety, impact on the quality of life, costs for the treatment of type 2 diabetes and its complications, the transfer of patients from Metformin BV to Metformin MB is preferable. Metformin MB therapy was associated with better control of the glycemic profile, which in the long term will reduce the incidence of complications. In addition, it was characterized by a lower frequency of adverse reactions from the gastrointestinal tract. These factors indirectly and in combination with better control over body weight were reflected in the form of an integral indicator of effectiveness [25].

Sitagliptin

DPP-4 inhibitors known as gliptins (sitagliptin, vildagliptin, saxagliptin, linagliptin, and alogliptin) represent a relatively new group of PSSPs.

The first and most studied representative of this class is sitagliptin (Januvia®).

In the domestic multicenter observational program “Dia-Da”, the results were analyzed in relation to 923 patients with type 2 diabetes with poor glycemic control (HbA1c> 7%), who initially did not receive drug therapy (14%) and received metformin at a dose of 1000-2000 mg / day (86%). At the time of inclusion in the program, the HbA1c level was 8.4%. At the same time, in 50% of patients it reached 7–8%, in 27% – 8–9%, in 14% – 9-10%, in 9% of patients – more than 10% [26].

After six months of combination therapy with sitagliptin and metformin, there was a significant decrease in HbA1c levels – by an average of 1.7% (from 8.4 to 6.7%) (Fig. 5).

Due to the high cardiovascular mortality among patients with type 2 diabetes, the cardiovascular safety of hypoglycemic therapy is especially important.

Cardiovascular outcomes with sitagliptin were evaluated in the largest randomized clinical trial TECOS. It was intended to show that the risk of cardiovascular events in patients treated with sitagliptin in addition to standard therapy does not exceed that of patients treated with standard therapy [27].

The study included 14,761 patients with type 2 diabetes. 7332 patients aged 65.4 ± 7.9 years were randomized to the sitagliptin therapy group, among them 2134 (29. 1%) women. The comparison group was comparable in terms of the indicated characteristics.

Analysis of the results for the primary composite endpoint showed no statistically significant differences between the groups. In addition, it was noted that the addition of sitagliptin to standard therapy does not lead to an increased risk of developing cardiovascular complications.

Of particular interest was the analysis of the results of the TECOS study for one of the secondary endpoints – the frequency of hospitalizations due to heart failure, since in the EXAMINE study there was a tendency to increase this indicator (by 19%), in the SAVOR-TIMI study – a significant increase (by 27%).

In the TECOS study, there were no differences between the groups in terms of both the rate of hospitalizations for heart failure and the rate of cardiovascular death.

Thus, these results suggest that sitagliptin has a good cardiovascular safety profile.

Fixed combination of sitagliptin and metformin MB

The new drug Janumet® Long is a fixed combination of metformin MB and the DPP-4 inhibitor sitagliptin.