Maximum Daily Dose of Januvia (Sitagliptin)
The maximum daily dose of sitagliptin (Januvia) is 100 mg once daily for patients with normal renal function or mild renal impairment (eGFR >50 mL/min/1.73 m²).
Dosing Based on Renal Function
Sitagliptin dosage must be adjusted according to renal function:
- Normal to mild renal impairment (eGFR >50 mL/min/1.73 m²): 100 mg once daily
- Moderate renal impairment (eGFR 30-50 mL/min/1.73 m²): 50 mg once daily
- Severe renal impairment (eGFR <30 mL/min/1.73 m²): 25 mg once daily 1
Administration Details
- Sitagliptin is taken as a single daily dose
- No dose titration is required when initiating therapy
- Can be taken with or without food
- Available as tablets (typically 25 mg, 50 mg, and 100 mg strengths)
Clinical Context
Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that works by increasing incretin levels, which:
- Stimulates insulin secretion in a glucose-dependent manner
- Inhibits glucagon secretion
- Slows gastric emptying
Unlike some other antidiabetic medications, sitagliptin:
- Does not cause weight gain (weight neutral) 2
- Has a low risk of hypoglycemia when used as monotherapy 3
- Can be used in combination with metformin, sulfonylureas, or thiazolidinediones
Common Pitfalls to Avoid
Failure to adjust dose in renal impairment: Always assess renal function before prescribing and adjust dose accordingly.
Overlooking drug interactions: While sitagliptin has fewer drug interactions than many diabetes medications, always review the patient's medication list.
Not monitoring renal function: Regular monitoring of renal function is important, especially in elderly patients or those at risk for kidney disease.
Cost considerations: Sitagliptin can be expensive compared to some other diabetes medications, with a median AWP of approximately $657 for a 30-day supply of the 100 mg daily dose 1.
Remember that while 100 mg daily is the maximum approved dose, this should only be used in patients with adequate renal function. Always adjust the dose based on the patient's specific renal status to ensure both efficacy and safety.