Januvia Vs. Metformin: Drug Comparison

Januvia^® (sitagliptin) is an oral medication used to manage type 2 diabetes by inhibiting the enzyme DPP-4, which increases the levels of incretin hormones that stimulate insulin release and reduce sugar production in the liver. Its FDA-approved indication is for improving blood sugar control in adults with type 2 diabetes, typically in combination with diet and exercise. Januvia is available in tablet form and is usually taken once daily. Common side effects include upper respiratory infections, headaches, and nausea, while more serious risks include pancreatitis and kidney dysfunction. Caution is advised in patients with kidney impairment or a history of pancreatitis.

Metformin is an oral medication commonly prescribed to manage blood sugar levels in individuals with type 2 diabetes. It works by decreasing glucose production in the liver, improving the body's sensitivity to insulin, and reducing the amount of sugar absorbed by the intestines. Metformin is often used as a first-line treatment due to its efficacy, safety profile, and additional benefits, such as weight stabilization and low risk of low blood sugar. Common side effects include gastrointestinal issues like nausea, diarrhea, and abdominal discomfort.

Dipeptidyl peptidase-4 (DPP-4) inhibitor

Biguinide

Januvia (sitagliptin) is indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Metformin hydrochloride tablets are indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus

• Typically taken orally once daily

• Comes in 25 mg, 50 mg, and 100 mg tablets

• Typically taken orally once, twice, or three times daily

• Comes in 500 mg, 850 mg, and 1,000 mg tablets

Adverse reactions reported in ≥5% of patients treated with Januvia and more commonly than in patients treated with placebo are:

• Upper respiratory tract infection

• Inflammation of the nose and throat

• Headache

In the add-on to sulfonylurea and add-on to insulin studies, low blood sugar was also more commonly reported in patients treated with Januvia compared to placebo

For metformin hydrochloride, the most common adverse reactions (>5%) are:

• Diarrhea

• Nausea/vomiting

• Flatulence

• Weakness

• Indigestion

• Abdominal discomfort

• Headache

• History of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema

• Severe renal impairment (eGFR below 30 mL/min/1.73 m²)

• Hypersensitivity to metformin

• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma

• Drug interactions: Carbonic anhydrase inhibitors, drugs that reduce metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine), alcohol

• Pancreatitis

• Heart failure

• Acute renal failure

• Low blood sugar with concomitant use with insulin or insulin secretagogues

• Hypersensitivity reactions

• Severe and disabling joint pain

• Bullous pemphigoid

• Lactic acidosis: See Boxed Warning

• Vitamin B12 deficiency: Metformin may lower vitamin B12 levels

• Low blood sugar with concomitant use with insulin and insulin secretagogues

• Females and males of reproductive potential: Potential for an unintended pregnancy

WARNING: LACTIC ACIDOSIS

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information.

If lactic acidosis is suspected, discontinue metformin hydrochloride tablets and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.

*This information is from the label for brand name Januvia^®. See the Full Prescribing Information for more complete information. Sitagliptin, the active ingredient in Januvia, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient sitagliptin.

*This information is from the metformin hydrochloride label used by Epic Pharma, LLC. See the Full Prescribing Information for more complete information. Metformin may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient metformin.