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Januvia vs Metformin

Drug facts and comparison

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Medically reviewed by  Jamie Winn, PharmD

Uses

  • As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
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  • Adults and children 10 years or older with Type 2 diabetes mellitus
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$49 per month
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Summary

Active ingredient: sitagliptin
Active ingredient: metformin
Indication: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
Indication: Adults and children 10 years or older with Type 2 diabetes mellitus

Side Effects

Most common

  • Increase in upper respiratory infections
  • Common cold
  • Headaches
  • Hypoglycemia (low blood sugar levels)
  • Vomiting
  • Constipation

More serious

  • Pancreatitis (inflammation of the pancreas
  • Severe allergic reactions including anaphylaxis, causing swelling in your face, mouth, and throat
  • Kidney problems or kidney disease
  • Joint pain
  • Hypoglycemia (low blood sugar levels)

Most common

  • Diarrhea
  • Flatulence
  • Nausea or vomiting
  • Bloating and constipation
  • Stomach pain
  • Heartburn
  • Headache
  • Weight loss

More serious

  • Lactic Acidosis
  • Vitamin B 12 Deficiency
  • Hypoglycemia

Drug Interactions

Severe Interaction
  • Antibiotics for bacterial infections such as gatifloxacin
  • Bexarotene used to treat skin cancer
Serious interaction
  • Diuretics – bendroflumethizaide, bumetanide, furosemide
  • ACE inhibitors – captopril, enalapril, ramipril
  • Corticosteroids – betamethasone, fludrocortisone, prednisolone
  • Anticonvulsants – phenytoin
  • Other diabetes treatments – insulin or a sulfonylurea
Moderate interaction
  • Steroids used topically (on the skin) such as betamethasone, clobetasol, hydrocortisone, and mometasone
Severe Interactions
  • Antibiotics for bacterial infections such as gatifloxacin
  • Treatments for epilepsy and migraine such as topiramate
Serious interactions
  • Diuretics such as bendroflumethiazide, bumetanide, furosemide
  • NSAIDs (Non-steroidal anti-inflammatory drugs such as bromfenac, diclofenac, ibuprofen, naproxen
  • Treatments for high blood pressure such as captopril, enalapril, ramipril
  • Corticosteroids such as betamethasone, cortisone, hydrocortisone, prednisolone
  • Antipsychotics such as clozapine
Moderate interactions
  • Antifungals such as itraconazole
  • Topical steroid treatments such as clobetasol and fluticasone

Warnings

You should not use Januvia if you:

  • Are allergic to the active ingredient sitagliptin
  • Are allergic to any of the other ingredients in Januvia
  • Have type 1 diabetes
  • Are under 18 years of age

You should talk to your doctor before using Januvia if you:

  • Have a history of pancreatitis
  • Have a heart condition
  • Have kidney disease
  • Are over 65 years of age

You should not use Metformin if you:

  • Are allergic to the active ingredient Metformin, or any other ingredients in Metformin
  • Have hypersensitivity to Metformin
  • Have severe renal impairment
  • Have liver or kidney disease
  • Have recently been treated for heart failure or heart attack
  • Have type 1 diabetes (Metformin  is for type 2 diabetes only)
  • Have acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
  • Are due for surgery or an x-ray

You should talk to your doctor before using Metformin if you:

  • Have kidney or liver problems
  • Consume excessive alcohol
  • Are over 65 years old
  • Are pregnant or are planning to become pregnant
  • Are breastfeeding or are planning to breastfeed

Dosage

Once daily

Once, twice or three times a day

Cost

30, 100 mg Januvia tablets will cost around $625

14, 500 mg Metformin oral tablets will cost $11

FAQs

Januvia is a brand-name prescription drug manufactured by Merck. It is known as a dipeptidyl peptidase 4 inhibitor (DPP-4 inhibitor) used in diabetes treatment to control blood glucose levels in type 2 diabetes mellitus. metformin is the name of a generic drug and is one of the earliest medications for diabetes. It belongs to the biguanides class of drugs and is used regularly as a first-line treatment for type 2 diabetes. Januvia is not available in a generic form and is considerably more expensive, while metformin is affordable for most patients.

Both drugs are U.S. Food and Drug Administration (FDA) approved and are included in the American Diabetes Association guidelines. These drugs can be used separately or together to gain glycemic control in diabetes patients. There is also a third option of using these drugs in a combination product called Janumet. Let us take a look at the differences and similarities between Januvia and metformin.

Conditions treated

Type 2 diabetes

Januvia and metformin are diabetes medicines to treat type 2 diabetes and can not be used to treat type 1 diabetes. What is type 2 diabetes?

In type 2 diabetes you do produce insulin, but the body can not use it effectively. There is usually a combination of a part failure of insulin production and a reduced response to the hormone. This is known as insulin resistance. Research does not give us a clear idea why some people develop this and others don’t, but lifestyle factors, e.g. lack of exercise and excess body weight can contribute to type 2 diabetes.

The first treatment recommended for type 2 diabetes is typically lifestyle changes, such as losing excess weight, getting regular exercise, and eating a healthier diet. If lifestyle changes do not work, then you may be prescribed medications to help lower your blood glucose. Most medications for type 2 diabetics are oral drugs like Januvia and metformin however, a few come as injections. Some people with type 2 diabetes may also need to use insulin.

Having diabetes means that glucose builds up in your bloodstream to a dangerous level. If this level is not reduced by medication and lifestyle changes eventually the body will be damaged. High blood sugar levels can cause a range of problems over time, including nerve damage, heart disease, strokes, and kidney failure.

Polycystic ovaries

Metformin is also used to treat polycystic ovaries and weight gain due to medications used for treating psychoses. Januvia is not indicated for this treatment.

Is Januvia better than Metformin?

In a 24-week clinical trial, both Januvia and metformin led to similar improvements in A1c levels in patients with type 2 diabetes. Although both treatments were generally well-tolerated, the incidence of gastrointestinal-related side effects was significantly lower with Januvia (11.6%) compared with metformin (20.7%).

What is Januvia?

Januvia is a prescription medicine used for

Januvia is taken as a pill that’s swallowed, usually once a day in the following doses: 25 mg, 50 mg, and 100 mg.

Januvia treats type 2 diabetes by helping to lower your blood sugar levels. It encourages your pancreas to produce insulin for longer after you’ve eaten, helping your body absorb more sugar out of your blood.

Januvia active ingredients

The active ingredient in Januvia is called sitagliptin. It works by increasing the amount of insulin you produce after you’ve eaten.

When you digest food, your stomach and gut produce digestive hormones called glucagon-like peptide-1 (GLP-1) and GIP. These hormones make your pancreas secrete insulin. As you continue to digest your food, the digestive hormones are broken down by an enzyme called dipeptidyl peptidase-4 (DPP-4) to allow your levels of insulin to fall again.

Sitagliptin stops the DPP-4 enzyme from breaking down the digestive hormones. This keeps the hormones active for longer, making you produce more insulin, and lowering your blood sugar to normal levels.

Side effects of Januvia

The most common side effects caused by Januvia include

  • Upper respiratory tract infections and the common cold
  • Headaches
  • Back pain
  • Hypoglycemia (low blood sugar levels)
  • Vomiting
  • Constipation

In rarer cases, Januvia can cause more serious side effects like

  • Inflammation of the pancreas (pancreatitis) that can be fatal in severe cases
  • Severe allergic reactions to the medication that can cause anaphylaxis – a potentially life-threatening condition where your immune system overreacts, causing swelling in your face, mouth, and throat causing trouble breathing
  • Kidney problems including the possible need for dialysis
  • Severe joint pain
  • Dangerously low blood sugar levels (hypoglycemia)

If you take Januvia you could experience side effects, including the most serious, but everyone reacts differently to medication. If you have any concerns about side effects, talk to your physician or a pharmacist.

Januvia drug interactions

Certain medications can interact with each other, affecting how they work and making some side effects more likely. Medications that are known or thought to interact with Januvia include:

  • Other medications that can lower blood sugar levels, like insulin or a sulfonylurea medicine
  • Digoxin used to treat a range of heart conditions

Januvia warnings & precautions

Don’t take Januvia if you:

  • Are allergic to the active ingredient sitagliptin
  • Are allergic to any of the other ingredients in Januvia (listed in the leaflet which comes with the medication)
  • Have type 1 diabetes
  • Are under 18 years of age

Talk to your doctor before taking Januvia if you:

  • Have a history of pancreatitis (inflammation of the pancreas)
  • Have a heart condition
  • Have kidney disease
  • Are over 65 years of age

How does Metformin work?

Metformin works in three ways:

  • It reduces the amount of glucose absorption from your food
  • It reduces the amount of glucose made by your liver
  • It increases your body’s response to insulin

Metformin is a very useful drug in that it reduces high blood sugar but does not cause hypoglycemia in patients with type 2 diabetes who are not using insulin injections. It can do this because it does not increase your insulin production like many other diabetes medications.

Side effects of Metformin

The most common side effects of metformin include:

  • Diarrhea
  • Flatulence
  • Nausea or vomiting
  • Bloating and constipation
  • Stomach pain
  • Heartburn
  • Headache
  • Weight loss

In rare instances, metformin can cause more serious side effects, including:

  • Lactic Acidosis
  • Vitamin B 12 Deficiency
  • Hypoglycemia

Metformin can also interact with the following medications:

  • Sulfonylureas when taken in combination with metformin can cause hypoglycemia
  • Cimetidine can cause the levels of metformin to rise

Give a complete list of all the prescription drugs, including over-the-counter meds, supplements, and medical conditions you may have to your healthcare provider. Talking with your doctor will allow them to pick up any drug interactions with metformin and help manage any possible side effects.

Metformin warnings and precautions

Don’t take metformin if you:

  • Are allergic to the active ingredient metformin, or any other ingredients in metformin
  • Have hypersensitivity to metformin
  • Have a severe renal impairment
  • Have liver or kidney disease
  • Have recently been treated for heart failure or heart attack
  • Have type 1 diabetes (metformin is for type 2 diabetes only)
  • Have acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
  • Are due for surgery or an x-ray

Talk to your doctor before taking metformin if you:

  • Have kidney or liver problems
  • Consume excessive alcohol
  • Are over 65 years old
  • Are pregnant or are planning to become pregnant
  • Are breastfeeding or are planning to breastfeed

Read the full prescribing information for Januvia and metformin and always speak with your healthcare provider for medical advice about your medicine so they can monitor and evaluate your condition. Always inform your healthcare provider of all medical conditions, and medications taken including over-the-counter meds and supplements. You are encouraged to report the adverse side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.
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