From the Guidelines
The starting dose of Janumet (sitagliptin/metformin) is typically one tablet of 50/500 mg taken twice daily with meals, providing 50 mg of sitagliptin and 500 mg of metformin per tablet, for a total daily dose of 100 mg sitagliptin and 1000 mg metformin. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of initiating therapy with a low dose and titrating as needed to minimize gastrointestinal side effects and optimize glycemic control 1.
Key Considerations
- The dose may be adjusted based on the patient's current glycemic control, response to treatment, and tolerability.
- Patients already on metformin may start Janumet at a dose that provides similar metformin amounts plus sitagliptin.
- The medication should be taken with food to reduce gastrointestinal side effects from the metformin component.
- Janumet combines two diabetes medications that work differently: sitagliptin increases incretin hormones that stimulate insulin release after meals, while metformin decreases glucose production in the liver and improves insulin sensitivity.
Special Populations
- Kidney function should be assessed before starting Janumet, as dosage adjustments are necessary for patients with reduced kidney function, with a maximum sitagliptin dose of 50 mg daily for patients with an eGFR of 30-44 mL/min/1.73 m2 and 25 mg once daily for those with an eGFR of 15-29 mL/min/1.73 m2 1.
- For patients with chronic kidney disease, the dose of Janumet should be adjusted according to the patient's eGFR, with careful consideration of the potential benefits and risks of therapy in this population.
Monitoring and Titration
- Patients should be monitored regularly for glycemic control, kidney function, and potential side effects, with dose adjustments made as needed to optimize outcomes.
- The goal of therapy is to achieve and maintain optimal glycemic control, while minimizing the risk of hypoglycemia, gastrointestinal side effects, and other adverse events.
From the Research
Starting Dose of Janumet
- The starting dose of Janumet, a fixed-dose combination of sitagliptin and metformin, is not explicitly stated in the provided studies.
- However, the studies suggest that the recommended dose of sitagliptin is 100 mg daily 2, 3, 4, 5, 6.
- For patients with moderate renal insufficiency, a dose of 50 mg once daily is recommended, while patients with severe renal insufficiency should receive 25 mg once daily 3.
- The dose of metformin in Janumet is not specified in the provided studies, but it is typically started at a low dose and gradually increased to minimize gastrointestinal side effects.
- It is essential to note that the dosage of Janumet may vary depending on the patient's renal function, and dosage adjustments may be necessary to minimize the risk of adverse effects 3.