Is Januvia (sitagliptin) the same as Jardiance (empagliflozin)?

Januvia (Sitagliptin) and Jardiance (Empagliflozin) Are Different Medications with Distinct Mechanisms and Benefits

No, Januvia (sitagliptin) and Jardiance (empagliflozin) are not the same medications - they belong to different drug classes with distinct mechanisms of action, benefits, and side effect profiles.

Medication Comparison

Januvia (Sitagliptin)

• Drug Class: Dipeptidyl peptidase-4 (DPP-4) inhibitor 1
• Mechanism: Increases incretin hormones by inhibiting DPP-4 enzyme, enhancing insulin secretion in a glucose-dependent manner 2, 3
• Cardiovascular Effects: Cardiovascular safety demonstrated but no proven cardiovascular benefit 4
• HbA1c Reduction: Approximately 0.5-0.8% 4, 5
• Weight Effects: Generally weight-neutral 6, 5
• Administration: 100 mg once daily 3
• Key Side Effects: Primarily gastrointestinal complaints (up to 16%), including abdominal pain, nausea, and diarrhea 3

Jardiance (Empagliflozin)

• Drug Class: Sodium-glucose cotransporter-2 (SGLT2) inhibitor 1, 7
• Mechanism: Inhibits SGLT2 in the kidneys, increasing urinary glucose excretion 7
• Cardiovascular Effects: Proven cardiovascular benefits - reduces cardiovascular death, hospitalization for heart failure, and all-cause mortality 4, 7
• HbA1c Reduction: Approximately 0.7-1.0% 4
• Weight Effects: Produces modest weight reduction 7
• Administration: Once daily oral dosing 7
• Key Side Effects: Risk of genital mycotic infections, euglycemic diabetic ketoacidosis, and volume depletion 4, 1

Clinical Implications of the Differences

Cardiovascular Benefits

• Empagliflozin (Jardiance) has demonstrated significant cardiovascular benefits in the EMPA-REG OUTCOME trial, showing reduced composite outcomes for myocardial infarction, stroke, and cardiovascular death 1, 4
• Sitagliptin (Januvia) has shown cardiovascular safety but no statistically significant differences in rates of major cardiovascular events compared to placebo 1

Renal Effects

• Empagliflozin has shown renoprotective properties and slows progression of diabetic kidney disease 4, 7
• Sitagliptin does not have significant documented renal benefits beyond glycemic control

Use in Treatment Algorithms

• First-line therapy: Metformin remains first-line for most patients with type 2 diabetes 4
• Second-line options:
  • For patients with established cardiovascular disease or high CV risk: Empagliflozin is preferred 1, 4
  • For patients with mild-to-moderate hyperglycemia without cardiovascular disease: Either medication could be appropriate, with selection based on patient-specific factors 1

Safety Considerations

Hypoglycemia Risk

• Both medications have a low inherent risk of hypoglycemia when used as monotherapy 2, 7
• Risk increases when combined with insulin or sulfonylureas 3, 1

FDA Warnings

• Empagliflozin (Jardiance): FDA warning about risk of euglycemic diabetic ketoacidosis - patients should stop taking SGLT2 inhibitors and seek medical attention if symptoms develop (dyspnea, nausea, vomiting, abdominal pain) 1
• Sitagliptin (Januvia): No specific FDA warnings of similar magnitude, though saxagliptin and alogliptin (other DPP-4 inhibitors) have warnings about increased heart failure risk 1

Conclusion

While both medications are used to treat type 2 diabetes, they work through completely different mechanisms and offer different benefits. For patients with established cardiovascular disease or at high cardiovascular risk, empagliflozin (Jardiance) offers significant cardiovascular protection that sitagliptin (Januvia) does not provide. However, sitagliptin may be appropriate for patients with mild hyperglycemia, particularly those who cannot tolerate SGLT2 inhibitors.