From the Guidelines
If you're taking Januvia (sitagliptin) for diabetes and need additional control, the most effective option to add would be an SGLT-2 inhibitor or a GLP-1 agonist, as recommended by the American College of Physicians 1. This combination works well because Januvia helps your body produce more insulin when needed, while SGLT-2 inhibitors like empagliflozin (Jardiance, 10-25mg daily) or dapagliflozin (Farxiga, 5-10mg daily) help remove excess glucose through urine, and GLP-1 receptor agonists such as semaglutide (Ozempic, weekly injection) or dulaglutide (Trulicity, weekly injection) improve blood sugar control and may assist with weight loss. Some key points to consider when adding a new medication include:
- Your current A1C level: If it's high, you may need a more potent medication or a combination of medications.
- Kidney function: Certain medications, like SGLT-2 inhibitors, may not be suitable for people with kidney disease.
- Heart health: Some medications, like GLP-1 agonists, may have cardiovascular benefits.
- Weight considerations: Some medications, like GLP-1 agonists, may help with weight loss.
- Risk of hypoglycemia: Some medications, like sulfonylureas, may increase the risk of hypoglycemia. The choice of medication should be based on your individual needs and health status, and should be discussed with your healthcare provider 1.
From the FDA Drug Label
Empagliflozin pharmacokinetics were similar with and without coadministration of metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin, verapamil, ramipril, and simvastatin in healthy volunteers and with or without coadministration of hydrochlorothiazide and torsemide in patients with type 2 diabetes Empagliflozin had no clinically relevant effect on the pharmacokinetics of metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin, digoxin, ramipril, simvastatin, hydrochlorothiazide, torsemide, and oral contraceptives when coadministered in healthy volunteers
The following medications can be added to Januvia (sitagliptin) for diabetes control:
- Metformin: as Empagliflozin pharmacokinetics were similar with and without coadministration of metformin
- Glimepiride: as Empagliflozin pharmacokinetics were similar with and without coadministration of glimepiride
- Pioglitazone: as Empagliflozin pharmacokinetics were similar with and without coadministration of pioglitazone
- Linagliptin: as Empagliflozin pharmacokinetics were similar with and without coadministration of linagliptin 2
From the Research
Combination Therapy for Diabetes Control
To improve diabetes control while taking Januvia, several options can be considered:
- Metformin: Studies have shown that combining sitagliptin (Januvia) with metformin can improve glycemic levels in diabetic patients 3, 4.
- Other antihyperglycaemic drugs: Sitagliptin can be used as add-on therapy to metformin or other antihyperglycaemic drugs, with or without metformin 5.
- Liraglutide or linagliptin: Although there is limited direct comparison, a study analyzed the indicators of diabetes mellitus after incorporating liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin, and found no statistical difference between the levels of glucose, glycated hemoglobin, weight, and blood pressure before and six months after the change 6.
Key Considerations
When considering combination therapy, it is essential to:
- Monitor glycemic control: Regularly check glucose, glycosylated hemoglobin, and blood pressure levels to assess the effectiveness of the treatment regimen 6.
- Evaluate safety profile: Although sitagliptin has been shown to be safe and effective, it is crucial to be aware of potential risks, such as rare pancreatic adverse events 5, 7.
- Adjust dosage: In cases of moderate to severe renal insufficiency, sitagliptin dosage may need to be adjusted 7.