From the Guidelines
Yes, Janumet (sitagliptin and metformin) and Jardiance (empagliflozin) can be taken together, but it's crucial to consider the patient's kidney function and adjust the dosages accordingly, as recommended by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) consensus report 1. This combination is often prescribed for patients with type 2 diabetes who need additional glucose control beyond what a single medication can provide. These medications work through different mechanisms:
- Janumet combines a DPP-4 inhibitor (sitagliptin) that increases insulin secretion and decreases glucagon with metformin which reduces glucose production in the liver and improves insulin sensitivity.
- Jardiance is an SGLT2 inhibitor that works by helping the kidneys remove excess sugar through urine. When taking these medications together, it's essential to follow the prescribed dosing schedule and monitor for side effects, such as potential hypoglycemia (low blood sugar), though this risk is lower than with some other diabetes medication combinations, as noted in the 2020 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1. Stay well-hydrated when taking Jardiance, as it increases urination. Regular blood glucose monitoring is essential when using multiple diabetes medications, and patients should report any unusual symptoms to their healthcare provider promptly. This combination may provide complementary benefits for blood glucose control, weight management, and potentially cardiovascular and kidney protection, as suggested by the 2021 KDIGO clinical practice guideline synopsis 1. Key considerations include:
- Monitoring kidney function and adjusting the dosages of Janumet and Jardiance as needed, based on the patient's eGFR levels.
- Being aware of potential adverse effects, such as genital mycotic infections, diabetic ketoacidosis, and increased risk for lower-extremity amputation.
- Educating patients on the importance of staying hydrated and monitoring their blood glucose levels regularly.
From the Research
Combination Therapy for Type 2 Diabetes
The question of whether Janumet (sitagliptin and metformin) and Jardiance (empagliflozin) can be taken together involves understanding the mechanisms of action of these drugs and the evidence regarding their combined use.
- Mechanism of Action:
- Janumet combines sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, with metformin, a biguanide. Sitagliptin works by increasing the levels of incretin hormones, which in turn increase insulin release in response to meals and decrease glucose production by the liver. Metformin decreases glucose production by the liver, improves the body's sensitivity to insulin, and thereby lowers blood sugar levels.
- Jardiance (empagliflozin) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor, which works by preventing the kidneys from reabsorbing glucose back into the blood, thereby increasing glucose excretion through urine and lowering blood glucose levels.
Evidence for Combination Therapy
- Studies on Empagliflozin:
- A study published in 2018 2 discusses empagliflozin as an effective and generally well-tolerated antihyperglycemic agent that can be used as monotherapy or as part of combination therapy with other antidiabetic agents.
- Another study from 2016 3 mentions that empagliflozin has a moderate glucose-lowering action and can be used in combination with other glucose-lowering drugs, highlighting its potential in reducing mortality, particularly due to heart failure, in patients with type 2 diabetes and established cardiovascular disease.
- Studies on Sitagliptin and Metformin Combination:
- A 2008 study 4 introduces Janumet, a combination of sitagliptin and metformin, as suitable for patients with type 2 diabetes, indicating that the combination has a complementary effect on glycemic control.
- A 2012 review 5 suggests that sitagliptin and metformin used together improve glycemic levels in diabetic patients, indicating a synergy between the agents, though it notes the need for more data on long-term effects and cost considerations.
- Combination of SGLT2 Inhibitors and Other Therapies:
- A 2017 review 6 discusses the potential benefits of combining SGLT2 inhibitors with GLP-1 receptor agonists, highlighting their complementary effects on glycemic control, body weight, cardiovascular risk factors, and outcomes. While this review does not specifically address the combination of Janumet and Jardiance, it suggests that combining therapies with different mechanisms of action can lead to improved outcomes for patients with type 2 diabetes.
Conclusion on Combination Use
Given the different mechanisms of action of Janumet (sitagliptin and metformin) and Jardiance (empagliflozin), and the evidence supporting the use of combination therapies in type 2 diabetes management, it is plausible that these two drugs could be used together to achieve better glycemic control and potentially reduce cardiovascular risk. However, the decision to use these medications in combination should be made under the guidance of a healthcare provider, considering the individual patient's needs, medical history, and potential for drug interactions or adverse effects.