Should Farxiga (dapagliflozin) and Januvia (sitagliptin) be taken in the morning or at night?

Timing of Farxiga and Januvia Administration

Both Farxiga (dapagliflozin) and Januvia (sitagliptin) can be taken at any time of day—morning or evening—based on patient convenience and adherence, as timing does not significantly impact their efficacy or cardiovascular outcomes.

Farxiga (Dapagliflozin) Timing

Evidence from Clinical Trials

• Dapagliflozin was studied and proven effective when administered in the morning (QAM) in the primary clinical trials, with the main efficacy cohort receiving morning doses that demonstrated significant improvements in HbA1c and fasting plasma glucose 1.
• A pharmacokinetic study demonstrated that dapagliflozin 10 mg once daily produces similar 24-hour glucose control whether given in the morning or evening, with comparable total urinary glucose excretion and percent inhibition of renal glucose reabsorption 2.

Practical Recommendation for Dapagliflozin

• Take dapagliflozin in the morning, as this was the primary dosing schedule used in pivotal trials 1.
• However, evening dosing is equally acceptable if it improves adherence, since pharmacokinetic data show equivalent glucose-lowering effects over 24 hours 2.
• The key is consistency—taking it at the same time each day matters more than the specific time chosen 2.

Januvia (Sitagliptin) Timing

Dosing Flexibility

• Sitagliptin 100 mg is administered once daily without need for titration or specific timing requirements 3.
• The drug works in a glucose-dependent manner to enhance postprandial insulin secretion, making it effective regardless of administration time 3.
• When combined with metformin (as Janumet), the complementary mechanisms provide additive glycemic control without timing restrictions 4.

Practical Recommendation for Sitagliptin

• Take sitagliptin at whatever time is most convenient for establishing a consistent daily routine 3.
• No evidence suggests superiority of morning versus evening dosing for DPP-4 inhibitors like sitagliptin.

General Principles Supporting Flexible Timing

Current Guideline Consensus

• The European Society of Cardiology explicitly recommends that antihypertensive and cardiovascular medications should be taken at the most convenient time of day to establish habitual patterns that improve adherence, with no evidence that bedtime dosing improves cardiovascular outcomes 5.
• The American Diabetes Association does not recommend preferential bedtime dosing of diabetes medications, as benefits from earlier studies have not been consistently reproduced 5.

Supporting Evidence

• The TIME study, a large prospective trial with over 21,000 participants, found no difference in major cardiovascular outcomes between evening and morning dosing of cardiovascular medications (HR 0.95% CI 0.83-1.10, p=0.53) 6.
• Patient preference and consistency in medication timing should be prioritized to optimize adherence rather than mandating a specific time of day 5.

Practical Algorithm for Timing Decision

Choose morning dosing if:

• Patient prefers morning routine 5
• Patient takes other morning medications 5
• Concern about nocturia with SGLT2 inhibitor (dapagliflozin causes increased urination) 1

Choose evening dosing if:

• Patient has difficulty remembering morning medications 5
• Morning schedule is rushed or inconsistent 5
• Patient experiences any daytime side effects that might be better tolerated at night 5

Important Caveats

• Dapagliflozin increases urinary glucose excretion and urination frequency—morning dosing may reduce nighttime bathroom trips 1, 2.
• Both medications can be taken with or without food 1, 3.
• Do not combine sitagliptin with GLP-1 receptor agonists, as there is no added glucose-lowering benefit beyond the GLP-1 RA alone 7.
• Consistency is paramount—whichever time is chosen, maintain the same schedule daily 5, 2.