From the Guidelines
Yes, Januvia (sitagliptin) and Farxiga (dapagliflozin) can be taken together as part of a diabetes treatment regimen, as long as the patient's kidney function is adequately monitored and the dosages are adjusted according to the patient's eGFR level, as recommended by the most recent guidelines 1.
Medication Mechanisms and Benefits
These medications work through different mechanisms: Januvia is a DPP-4 inhibitor that increases insulin production and decreases glucagon, while Farxiga is an SGLT2 inhibitor that helps the kidneys remove excess glucose through urine.
- The combination of Januvia and Farxiga may provide complementary benefits, including improved glycemic control without increased hypoglycemia risk, as supported by the latest standards of care in diabetes 1.
- According to the guidelines, SGLT2 inhibitors like Farxiga have been shown to have benefits for cardiovascular and kidney outcomes, even in patients with reduced kidney function 1.
Dosage and Monitoring Considerations
When taking both medications, follow your prescribed dosages, which typically include Januvia 100 mg once daily and Farxiga 5-10 mg once daily.
- However, the dosage of Farxiga may need to be adjusted based on the patient's eGFR level, with a maximum daily dose of 10 mg for patients with an eGFR of 25-44 mL/min/1.73 m2, as recommended by the consensus report on diabetes management in chronic kidney disease 1.
- Regular monitoring of kidney function, blood glucose levels, and overall response to treatment is crucial to ensure the safe and effective use of these medications.
Potential Side Effects and Risks
Be aware that side effects can include urinary tract infections, genital yeast infections, and potential dehydration from Farxiga, while Januvia may cause upper respiratory infections or headaches.
- Patients should be educated on the signs and symptoms of these potential side effects and instructed to seek medical attention if they experience any unusual or severe symptoms.
- The risk of diabetic ketoacidosis (DKA) and other adverse effects should also be carefully considered and monitored, particularly in patients with reduced kidney function or other underlying health conditions 1.
From the Research
Combination Therapy with Januvia and Farxiga
- The use of Januvia (Sitagliptin) and Farxiga (Dapagliflozin) together has not been directly studied in the provided evidence, but both drugs have been shown to be effective in managing type 2 diabetes mellitus 2, 3, 4.
- Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, has been found to improve glycaemic control in patients with type 2 diabetes, with a low risk of hypoglycaemia and a neutral effect on body weight 2, 3.
- Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to reduce the risk of cardiovascular death or hospitalization for heart failure in patients with type 2 diabetes, and has also been approved for the treatment of symptomatic heart failure with reduced ejection fraction 4.
- Combination therapy with a GLP-1 receptor agonist and an SGLT2 inhibitor, such as dapagliflozin, has been found to be effective in reducing HbA1c, body weight, and cardiovascular risk factors, and may produce additive cardiovascular benefits 5, 6.
- While there is no direct evidence on the combination of Januvia and Farxiga, the available data suggest that combination therapy with a DPP-4 inhibitor and an SGLT2 inhibitor may be a viable treatment option for patients with type 2 diabetes, and could potentially provide complementary benefits in terms of glycaemic control, weight loss, and cardiovascular risk reduction 5, 6.