From the Guidelines
Yes, Sitagliptin (Januvia) can be taken with Empagliflozin (Jardiance), but the dosage of Empagliflozin should be limited to 10 mg daily, especially in patients with reduced eGFR, as its use is not recommended with eGFR <45 mL/min/1.73 m2, according to the consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Medication Mechanism and Dosage
These medications work through different mechanisms to help control blood sugar in people with type 2 diabetes. Sitagliptin is a DPP-4 inhibitor that helps increase insulin production and decrease glucagon levels, while Empagliflozin is an SGLT2 inhibitor that helps the kidneys remove excess glucose through urine.
- Typical dosages are:
- Sitagliptin: Maximum 50 mg daily for patients with eGFR 30-44 mL/min/1.73 m2 and maximum 25 mg once daily for patients with eGFR 15-29 mL/min/1.73 m2 1
- Empagliflozin: 10 mg daily, with initiation not recommended with eGFR <30 mL/min/1.73 m2 for glycemic control or <20 mL/min/1.73 m2 for heart failure 1
Important Considerations
Always take these medications exactly as prescribed by your doctor, usually in the morning with or without food. It's essential to maintain consistent timing of doses and to stay well-hydrated, especially when taking Empagliflozin.
- Monitor your blood sugar levels regularly and watch for any side effects.
- Inform your healthcare provider about all medications you're taking to avoid potential interactions or adjust dosages if needed.
Combination Therapy
When used in combination, Sitagliptin and Empagliflozin can provide complementary effects on blood sugar control. However, it's crucial to consider the patient's kidney function and adjust the dosages accordingly to minimize potential risks and maximize benefits, as recommended by the ADA and KDIGO consensus report 1.
From the Research
Combination Therapy for Type 2 Diabetes
- Sitagliptin (Januvia) and empagliflozin (Jardiance) are two medications used to treat type 2 diabetes, but their combined use is not directly addressed in the provided studies.
- Sitagliptin is a DPP-4 inhibitor that enhances the body's own ability to control blood glucose 2.
- Empagliflozin is an SGLT2 inhibitor that improves glycaemic control, promotes weight loss, and lowers blood pressure 3.
Potential Interactions and Side Effects
- The combination of sitagliptin and empagliflozin may increase the risk of adverse effects such as hypoglycaemia, urinary tract infections, and pancreatitis 4.
- Empagliflozin has been shown to have a diuretic effect, which can lead to volume depletion and a fall in blood pressure, especially during co-administration with other diuretics or antihypertensive drugs 5.
- Sitagliptin has been found to have a low risk of hypoglycaemia and no effect on body weight 2.
Clinical Evidence
- A study on empagliflozin found that it reduced mortality in patients with type 2 diabetes and significant cardiovascular risk factors, but this benefit was not related to its hypoglycaemic effect 5.
- Another study compared the effectiveness of SGLT2 inhibitors, including empagliflozin, and found that they were effective in improving glycaemic control, but had adverse effects such as urinary and genital tract infections 3.
- There is limited evidence on the combined use of sitagliptin and empagliflozin, and more studies are needed to assess their safety and efficacy in combination therapy 6, 3.