Can Glipizide (Glibenclamide) and Januvia (Sitagliptin) be used together?

From the Guidelines

Yes, Glipizide and Januvia can be used together as a combination therapy for type 2 diabetes. This combination is based on the most recent evidence from the 2025 standards of care in diabetes, which suggests that combination therapy can be effective for patients who do not achieve adequate blood glucose control with a single medication 1. The key points to consider when using this combination include:

• Glipizide is a sulfonylurea that stimulates the pancreas to release more insulin, while Januvia (Sitagliptin) is a DPP-4 inhibitor that increases incretin hormones, which help regulate insulin production and reduce glucagon secretion.
• The combination may increase the risk of hypoglycemia (low blood sugar), especially in elderly patients or those with kidney impairment, as noted in the 2025 standards of care in diabetes 1.
• Dosing typically starts with lower amounts of each medication and is adjusted based on blood glucose monitoring results.
• Patients using this combination should be aware of hypoglycemia symptoms (shakiness, sweating, confusion) and have a plan to treat it.
• Regular monitoring of kidney function is also important as dosage adjustments may be needed if kidney function declines, as indicated in the 2025 standards of care in diabetes 1. It's also worth noting that the 2022 standards of medical care in diabetes provide information on the median monthly costs of noninsulin glucose-lowering agents, including Glipizide and Januvia, but this information is not directly relevant to the decision to use these medications together 1. Overall, the combination of Glipizide and Januvia can be a useful treatment option for patients with type 2 diabetes, but it requires careful monitoring and dose adjustment to minimize the risk of hypoglycemia and other adverse effects.

From the FDA Drug Label

Initial combination therapy or maintenance of combination therapy may not be appropriate for all patients. These management options are left to the discretion of the health care provider. The efficacy of JANUVIA was evaluated in a 52-week, double-blind, glipizide-controlled noninferiority trial in patients with type 2 diabetes Patients receiving glipizide were given an initial dosage of 5 mg/day and then electively titrated over the next 18 weeks to a maximum dosage of 20 mg/day as needed to optimize glycemic control The mean dose of glipizide after the titration period was 10 mg. After 52 weeks, JANUVIA and glipizide had similar mean reductions from baseline in A1C in the intent-to-treat analysis

GLIPIZIDE AND JANUVIA CAN BE USED TOGETHER as there is a study that compared the efficacy of JANUVIA to glipizide as add-on therapy in patients inadequately controlled on metformin. However, the decision to use them together should be left to the discretion of the health care provider 2.

• Key points to consider:
  • The study compared JANUVIA to glipizide, not the combination of both.
  • The incidence of hypoglycemia was significantly lower in the JANUVIA group compared to the glipizide group.
  • Patients treated with JANUVIA exhibited a significant mean decrease from baseline in body weight compared to a significant weight gain in patients administered glipizide.

From the Research

Combination Therapy with Glipizide and Januvia

• The use of Glipizide (Glibenclamide) and Januvia (Sitagliptin) together is a subject of interest in the management of type 2 diabetes mellitus.
• According to a study published in 2007 3, sitagliptin was shown to be noninferior to glipizide as an add-on agent in patients inadequately controlled on metformin alone.
• Another study from 2010 4 found that sitagliptin monotherapy was noninferior to metformin monotherapy in terms of the reduction in HbA(1c) levels, and significant reductions in HbA(1c) levels were observed with sitagliptin add-on therapy to ongoing treatment with thiazolidinediones, sulfonylureas, or insulin with or without metformin.
• The combination of sitagliptin with other antidiabetic agents, including sulfonylureas like glipizide, is mentioned in the study from 2008 5, which discusses the combination tablet of sitagliptin and metformin HCl (Janumet) and its approval for use in patients not adequately controlled by taking either sitagliptin or metformin HCl alone.
• A review from 2014 6 highlights the efficacy and safety of sitagliptin in improving glycemic control in patients with type 2 diabetes, including its use as monotherapy or add-on therapy to metformin or other antihyperglycemic drugs.
• While there is no direct study comparing the combination of glipizide and januvia, the available evidence suggests that sitagliptin can be used in combination with other antidiabetic agents, including sulfonylureas like glipizide, to achieve better glycemic control 3, 4, 6.
• However, it is essential to consider the potential risk of hypoglycemia when combining sitagliptin with sulfonylureas like glipizide, as mentioned in the study from 2010 4.
• An older study from 1987 7 discusses the effects of short-term insulin therapy on the therapeutic response to glipizide, but it does not provide direct evidence for the combination of glipizide and januvia.

Key Considerations

• The combination of glipizide and januvia may be used to achieve better glycemic control in patients with type 2 diabetes mellitus.
• However, the potential risk of hypoglycemia and other adverse effects should be carefully considered when using this combination therapy.
• More research is needed to fully understand the efficacy and safety of combining glipizide and januvia in the management of type 2 diabetes.