From the Guidelines
Semaglutide and Januvia (sitagliptin) can be used together in patients with type 2 diabetes, though this combination is not commonly prescribed due to overlapping mechanisms. Both medications work on the incretin system but through different pathways - semaglutide directly activates GLP-1 receptors while sitagliptin inhibits DPP-4, the enzyme that breaks down natural GLP-1. When used together, patients typically continue their usual doses: semaglutide (0.25-2.0 mg weekly for Ozempic or 3-7 mg daily for Rybelsus) and sitagliptin (100 mg daily, or lower doses for kidney impairment) 1. Patients should monitor for enhanced side effects like nausea, vomiting, or hypoglycemia, especially if also taking sulfonylureas or insulin. The combination may provide additional glucose-lowering benefits in patients not achieving targets on either medication alone, though the incremental benefit of sitagliptin when added to semaglutide is often modest. Many clinicians prefer to discontinue sitagliptin when starting semaglutide due to the stronger glucose-lowering effect of GLP-1 receptor agonists and to simplify the medication regimen. It's worth noting that GLP-1 receptor agonists, such as semaglutide, have shown cardiovascular and kidney benefits, making them a preferred choice for patients with type 2 diabetes and established cardiovascular disease or kidney disease 1. In contrast, the benefits of DPP-4 inhibitors like sitagliptin are more modest, and their use is generally recommended when GLP-1 receptor agonists are not tolerated or contraindicated 1. Therefore, the decision to use semaglutide and Januvia together should be individualized and based on the patient's specific clinical needs and circumstances.
Some key points to consider when using this combination include:
- Monitoring for adverse effects, such as gastrointestinal symptoms and hypoglycemia
- Adjusting doses of concomitant medications, such as sulfonylureas or insulin, to minimize the risk of hypoglycemia
- Regularly assessing the patient's kidney function and adjusting the dose of sitagliptin as needed
- Considering the potential benefits and risks of continuing sitagliptin in patients who are already taking semaglutide, and discontinuing it if necessary to simplify the medication regimen. Overall, the use of semaglutide and Januvia together should be guided by the principles of evidence-based medicine and tailored to the individual patient's needs and circumstances.
From the FDA Drug Label
7.1 Concomitant Use with an Insulin Secretagogue (e.g., Sulfonylurea) or with Insulin The risk of hypoglycemia is increased when OZEMPIC is used in combination with insulin secretagogues (e.g., sulfonylureas) or insulin. 7.2 Oral Medications OZEMPIC causes a delay of gastric emptying, and thereby has the potential to impact the absorption of concomitantly administered oral medications.
The FDA drug label does not answer the question about using semaglutide and Januvia (sitagliptin) together in patients with type 2 diabetes, as it does not specifically mention the use of semaglutide with sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor.
From the Research
Combination Therapy with Semaglutide and Januvia
- Semaglutide, a GLP-1 receptor agonist, and Januvia (sitagliptin), a dipeptidyl peptidase-4 enzyme inhibitor, are both used in the treatment of type 2 diabetes 2, 3.
- There is evidence to suggest that GLP-1 receptor agonists like semaglutide can be combined with other glucose-lowering agents, including dipeptidyl peptidase-4 inhibitors like sitagliptin, to achieve better glycemic control 2.
- The safety and efficacy of combining semaglutide with sitagliptin have not been directly studied in the provided evidence, but both drugs have been shown to be effective and generally well-tolerated in patients with type 2 diabetes 3, 4, 5, 6.
Mechanisms of Action
- Semaglutide works by augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, decelerating gastric emptying, and reducing calorie intake and body weight 2.
- Sitagliptin increases the amount of circulating incretins, which stimulate insulin secretion and inhibit glucose production 3.
Safety and Efficacy
- Semaglutide has been shown to have a favorable risk/benefit profile for patients with type 2 diabetes, with benefits including improved glycemic control, weight loss, and cardiovascular risk reduction 4, 6.
- Sitagliptin has been shown to be effective in improving glycemic control in patients with type 2 diabetes, with a low risk of hypoglycemia and minimal impact on body weight 3.
- The combination of semaglutide and sitagliptin may be beneficial for patients with type 2 diabetes who require additional glucose-lowering therapy, but further studies are needed to confirm the safety and efficacy of this combination 2.