Januvia Vs. Rybelsus: 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.

Rybelsus^® (semaglutide) is an oral medication used to improve blood sugar control in adults with type 2 diabetes. It is the first glucagon-like peptide-1 (GLP-1) receptor agonist available in tablet form. It stimulates insulin secretion, inhibits glucagon release, and slows gastric emptying to lower blood sugar levels. Rybelsus is taken once daily and can be used alone or in combination with other diabetes medications, along with diet and exercise. Common side effects include nausea, diarrhea, and abdominal pain, and it should be used cautiously in patients with a history of pancreatitis.

Dipeptidyl peptidase-4 (DPP-4) inhibitor

Glucagon-like peptide-1 (GLP-1) receptor agonist

Januvia (sitagliptin) is indicated:

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

Rybelsus (semaglutide) is indicated:

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

• Typically taken orally once daily

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

• Typically taken orally once daily

• Comes in 3 mg, 7 mg, and 14 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

Most common adverse reactions (incidence ≥5%) are:

• Nausea

• Abdominal pain

• Diarrhea

• Decreased appetite

• Vomiting

• Constipation

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

• Personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2

• Prior serious hypersensitivity reaction to semaglutide or any of the excipients in Rybelsus

• Drug interactions: oral medications—Rybelsus delays gastric emptying

• 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

• Pancreatitis

• Diabetic retinopathy complications

• Low blood sugar: Concomitant use with an insulin secretagogue or insulin may increase the risk of low blood sugar, including severe low blood sugar

• Acute kidney injury

• Hypersensitivity reactions

• Acute gallbladder disease

• Pregnancy: May cause fetal harm

• Breastfeeding: Breastfeeding not recommended

• Females and males of reproductive potential: Discontinue Rybelsus in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide

WARNING: RISK OF THYROID C-CELL TUMORS

In rodents, semaglutide causes thyroid C-cell tumors. It is unknown whether Rybelsus causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined.

Rybelsus is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors.

*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 label for brand name Rybelsus^®. See the Full Prescribing Information for more complete information. Semaglutide, the active ingredient in Rybelsus, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient semaglutide.