What are the common side effects of Januvia (sitagliptin)?

Common Side Effects of Januvia (Sitagliptin)

Januvia (sitagliptin) is generally well-tolerated with a neutral effect on weight and low risk of hypoglycemia, with the most common side effects being upper respiratory tract infections, nasopharyngitis, headache, and gastrointestinal complaints including abdominal pain, nausea, and diarrhea. 1, 2, 3

Gastrointestinal Side Effects

• Stomach discomfort, abdominal pain, nausea, and diarrhea occur in up to 16% of patients, though these rates are often similar to placebo 2, 3
• These gastrointestinal symptoms are typically mild and self-limiting 4

Respiratory Symptoms

• Upper respiratory tract infections are among the most frequently reported adverse events 2, 5
• Nasopharyngitis (stuffy or runny nose) and sore throat commonly occur 2

Neurological Effects

• Headache is a commonly reported side effect 2, 5

Metabolic Considerations

• Hypoglycemia risk is low when sitagliptin is used alone (similar to placebo rates), but increases when combined with sulfonylureas or insulin 1, 3, 4
• Weight neutral effect: Unlike many diabetes medications, sitagliptin does not cause weight gain 1, 2, 4

Serious but Rare Adverse Events

• Pancreatitis has been reported in clinical trials, though causality has not been definitively established; discontinue if pancreatitis is suspected 1
• Joint pain (arthralgia) has been reported in postmarketing surveillance 1
• Bullous pemphigoid: Consider discontinuing if this debilitating skin condition develops and other treatment options are feasible 1

Hypersensitivity Reactions

• Serious hypersensitivity reactions including anaphylaxis and angioedema are contraindications to sitagliptin use 6

Important Clinical Pearls

• The overall tolerability profile is excellent, with adverse events occurring at rates similar to placebo in most studies 2, 7, 4
• No dose titration or home blood glucose monitoring is required for initiation, making it simple to use 7
• Dose adjustment is required for patients with moderate-to-severe renal impairment (reduce to 25-50 mg once daily) 1, 3
• The low hypoglycemia risk and weight-neutral profile make sitagliptin particularly advantageous compared to sulfonylureas and thiazolidinediones 2, 4