What are alternative medications to Januvia (Sitagliptin) 100 mg?

From the Guidelines

Alternative medications to Januvia (sitagliptin) 100 mg include other DPP-4 inhibitors such as Tradjenta (linagliptin) 5 mg daily, Onglyza (saxagliptin) 2.5-5 mg daily, and Nesina (alogliptin) 25 mg daily, as well as GLP-1 receptor agonists like Ozempic (semaglutide) 0.25-1 mg weekly injection, which has demonstrated evidence of cardiovascular benefit in large CV outcome trials 1.

When considering alternative medications, several factors should be taken into account, including:

• Kidney function: According to the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) consensus report, dose adjustments are necessary for certain medications, such as DPP-4 inhibitors, in patients with chronic kidney disease 1.
• Cardiovascular risk: Medications like GLP-1 receptor agonists and SGLT-2 inhibitors have shown cardiovascular benefits in clinical trials 1.
• Weight management goals: Certain medications, such as GLP-1 receptor agonists, can aid in weight loss, while others, like sulfonylureas, may lead to weight gain 1.
• Cost considerations: The cost of medications can vary significantly, and healthcare providers should consider this factor when selecting an alternative medication.

Other classes of diabetes medications can also be considered, including:

• SGLT-2 inhibitors, such as Jardiance (empagliflozin) 10-25 mg daily or Farxiga (dapagliflozin) 5-10 mg daily, which have shown benefits in reducing glucose reabsorption in the kidneys and improving cardiovascular outcomes 1.
• Sulfonylureas, like glipizide 5-20 mg daily, which increase insulin secretion, but may carry a higher risk of hypoglycemia 1.
• Metformin 500-2000 mg daily, which improves insulin sensitivity, but may not be suitable for patients with kidney impairment 1.

It is essential to consult with a healthcare provider before switching medications to ensure the alternative is appropriate for the individual's specific health situation, taking into account their medical history, current medications, and lifestyle factors.

From the FDA Drug Label

INVOKANA 300 mg versus sitagliptin 100 mg in combination with metformin HCl and sulfonylurea. At the end of treatment, INVOKANA 300 mg provided greater HbA 1C reduction compared to sitagliptin 100 mg when added to metformin HCl and sulfonylurea (p<0. 05).

Alternative medications to Januvia (Sitagliptin) 100 mg are:

• INVOKANA 300 mg: as it provided greater HbA 1C reduction compared to sitagliptin 100 mg when added to metformin HCl and sulfonylurea. 2

From the Research

Alternative Medications to Januvia (Sitagliptin) 100 mg

There are several alternative medications to Januvia (Sitagliptin) 100 mg for the treatment of type 2 diabetes. Some of these alternatives include:

• Metformin: a biguanide that decreases glucose production in the liver and increases insulin sensitivity 3
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors: such as canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, ipragliflozin, luseogliflozin, and tofogliflozin, which work by reducing glucose reabsorption in the kidneys 4
• Glucagon-like peptide-1 (GLP-1) receptor agonists: such as exenatide, liraglutide, and semaglutide, which mimic the action of the GLP-1 hormone to increase insulin secretion and decrease glucose production in the liver 5
• Other dipeptidyl peptidase-4 (DPP-4) inhibitors: such as linagliptin, saxagliptin, and teneligliptin, which work by increasing the levels of GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) to increase insulin secretion and decrease glucose production in the liver 4

Combination Therapies

Combination therapies that include a DPP-4 inhibitor, such as sitagliptin, with other medications, such as metformin and an SGLT2 inhibitor, have been shown to be effective in improving glycemic control and reducing the risk of cardiovascular events 4, 3. For example, a study found that initial triple combination therapy with metformin, sitagliptin, and empagliflozin led to significant improvements in glycemic control and metabolic function, with no serious adverse events 3.

Safety and Efficacy

The safety and efficacy of these alternative medications and combination therapies have been established in several clinical trials 6, 7, 4, 3, 5. However, it is essential to note that the choice of medication or combination therapy should be individualized based on the patient's specific needs and medical history.