Can you take Januvia (Sitagliptin) and Jardiance (Empagliflozin) at the same time?

Can You Take Januvia and Jardiance Together?

Yes, you can safely take Januvia (sitagliptin) and Jardiance (empagliflozin) at the same time—this combination is clinically appropriate and commonly used in type 2 diabetes management. 1, 2

Why This Combination Works

These medications have complementary mechanisms of action that work synergistically:

• Jardiance (empagliflozin) is an SGLT2 inhibitor that works by blocking glucose reabsorption in the kidneys, causing excess glucose to be eliminated in urine 3
• Januvia (sitagliptin) is a DPP-4 inhibitor that enhances your body's natural insulin secretion and reduces glucagon in a glucose-dependent manner 4, 5
• The combination provides additive glucose-lowering effects through different pathways, typically reducing HbA1c by approximately 0.4-0.9% from the DPP-4 inhibitor plus the SGLT2 inhibitor's effect 4, 2

Clinical Evidence Supporting Combined Use

Current diabetes guidelines explicitly support using these medications together:

• The American Diabetes Association 2025 guidelines recommend combination therapy with multiple glucose-lowering agents when needed to achieve glycemic targets 1
• The combination is particularly valuable when metformin alone is insufficient or when patients have cardiovascular or kidney disease requiring SGLT2 inhibitor therapy 2
• Both medications have low hypoglycemia risk when used together, as neither depends on insulin secretion in a way that causes dangerous blood sugar drops 4, 5

Important Safety Considerations

Monitor for these specific issues when taking both medications:

• Genital infections: Jardiance increases risk of yeast infections due to glucose in urine; maintain meticulous hygiene 1
• Volume depletion: Jardiance has diuretic effects; ensure adequate hydration, especially if taking other blood pressure medications 6
• Kidney function: Both medications require monitoring of kidney function, though sitagliptin needs dose adjustment if eGFR falls below 45 mL/min/1.73 m² while Jardiance can be continued down to eGFR >20 4, 2
• Diabetic ketoacidosis: Rare but serious risk with Jardiance; seek immediate care for nausea, vomiting, or abdominal pain 1

Dosing Adjustments Based on Kidney Function

If you have kidney disease, sitagliptin dosing must be adjusted:

• Normal kidney function (eGFR ≥45): Sitagliptin 100 mg daily 4
• Moderate impairment (eGFR 30-44): Sitagliptin 50 mg daily 4
• Severe impairment (eGFR <30): Sitagliptin 25 mg daily 4
• Jardiance: Can be initiated if eGFR >20 mL/min/1.73 m² without dose adjustment 2

When to Avoid This Combination

Do NOT use this combination if:

• You are also taking a GLP-1 receptor agonist (like Ozempic, Trulicity, or Victoza), as DPP-4 inhibitors provide no additional benefit beyond the GLP-1 RA and should not be combined 1, 2
• You have a history of severe allergic reaction to either medication 4
• You have type 1 diabetes or diabetic ketoacidosis 3

Common Pitfalls to Avoid

Key mistakes to watch for:

• Don't combine with GLP-1 agonists: If your doctor wants to add a GLP-1 RA for cardiovascular benefits, the sitagliptin should be discontinued first 1, 2
• Avoid saxagliptin specifically: If switching DPP-4 inhibitors, avoid saxagliptin due to heart failure risk; sitagliptin is cardiovascularly safe 4
• Monitor for hypoglycemia if on other medications: If you're also taking sulfonylureas (glipizide, glyburide) or insulin, these doses may need reduction when adding either medication to prevent low blood sugar 1

Cardiovascular and Kidney Benefits

This combination offers protection beyond glucose control:

• Jardiance has proven cardiovascular mortality reduction and heart failure benefits in patients with established heart disease 3, 6
• Jardiance provides kidney protection and slows progression of diabetic kidney disease 2
• Sitagliptin has demonstrated cardiovascular safety (neutral effect, no harm) in the TECOS trial 4, 5