From the Guidelines
The maximum recommended dose of Janumet (sitagliptin and metformin) is 100 mg sitagliptin/2000 mg metformin daily, typically given as 50 mg sitagliptin/1000 mg metformin twice daily. This dosing is based on the latest evidence from the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) consensus report 1. It's essential to note that patients with renal impairment require dose adjustments, and according to the report, the maximum dose of sitagliptin is 50 mg daily for patients with an estimated glomerular filtration rate (eGFR) between 30-44 mL/min/1.73 m², and 25 mg once daily for those with an eGFR between 15-29 mL/min/1.73 m² 1.
Some key points to consider when prescribing Janumet include:
- Dosing should be individualized based on the patient's current antidiabetic regimen, effectiveness, and tolerability, with gradual titration recommended to minimize gastrointestinal side effects.
- The medication should be taken with meals to reduce gastrointestinal side effects from the metformin component.
- Patients with an eGFR below 30 mL/min/1.73 m² require careful consideration, and Janumet is not recommended for those with severe renal impairment.
- The dual mechanism of action works by both inhibiting DPP-4 enzyme (sitagliptin), which increases incretin hormones that stimulate insulin release, and reducing hepatic glucose production while improving insulin sensitivity (metformin).
- Common side effects include diarrhea, nausea, abdominal discomfort, and headache, and patients should be monitored for the rare but serious risk of lactic acidosis.
From the Research
Maximum Recommended Dose of Janumet
The maximum recommended dose of Janumet (sitagliptin and metformin) is not explicitly stated in the provided studies. However, the studies provide information on the dosages of sitagliptin and metformin used in clinical trials.
- The study 2 mentions that sitagliptin was used as monotherapy or in combination with metformin, but it does not specify the maximum recommended dose.
- The study 3 compares the efficacy of oral semaglutide with sitagliptin, and it mentions that sitagliptin was used at a dose of 100 mg.
- The study 4 also compares the efficacy of semaglutide with sitagliptin, and it mentions that sitagliptin was used at a dose of 100 mg.
- The study 5 provides a comparison of the efficacy and safety of 10 glucagon-like peptide-1 receptor agonists, including semaglutide, but it does not provide information on the maximum recommended dose of Janumet.
Dosage Information
Based on the provided studies, the dosage of sitagliptin used in clinical trials was 100 mg. However, it is essential to consult the prescribing information or a healthcare professional to determine the maximum recommended dose of Janumet for a specific patient.
- The typical dosage of sitagliptin is 100 mg once daily, and it can be used in combination with metformin.
- The maximum recommended dose of metformin is not explicitly stated in the provided studies, but it is typically 2000 mg per day, divided into two or three doses.
- The dosage of Janumet (sitagliptin and metformin) will depend on the individual patient's needs and medical history, and it should be determined by a healthcare professional.