Can Januvia and Jardiance be taken together? An Expert Analysis

In the United States, an adult with diagnosed diabetes takes an average of 5.9 different prescription medications [1.8.6]. For many with type 2 diabetes, a key question is: Can Januvia and Jardiance be taken together for better glycemic control? [1.2.1, 1.2.2]

Quick Summary

Yes, healthcare providers can prescribe Januvia and Jardiance together. This combination uses two different mechanisms to lower blood sugar and can be more effective than either drug alone, though it requires monitoring [1.2.1, 1.2.4, 1.6.2].

Key Points

• Can be taken together: Healthcare providers can and do prescribe Januvia (sitagliptin) and Jardiance (empagliflozin) together for type 2 diabetes [1.2.1, 1.2.2].

• Complementary Mechanisms: They work in different ways; Januvia increases insulin release while Jardiance removes excess sugar via urine, providing better blood sugar control [1.3.1, 1.4.1].

• Enhanced Efficacy: Studies show that combining an SGLT2 inhibitor (like Jardiance) with a DPP-4 inhibitor (like Januvia) is more effective for glycemic control than either drug alone [1.7.1, 1.7.4].

• No Direct Interaction: There are no known negative drug-to-drug interactions between Januvia and Jardiance [1.2.6].

• Side Effect Profile: The combination carries the potential side effects of both drugs, such as an increased risk of UTIs from Jardiance and rare risks like pancreatitis from Januvia [1.4.1, 1.5.4].

• Added Benefits: Jardiance offers additional proven benefits for reducing cardiovascular and kidney disease risks, which are retained in combination therapy [1.5.5].

• Consult a Doctor: The decision to use this combination therapy must be made by a healthcare professional based on a patient's overall health and kidney function [1.2.1].

The Rise of Combination Therapy in Type 2 Diabetes

Managing type 2 diabetes often requires a multi-faceted approach, and for many patients, a single medication isn't enough to achieve target blood sugar levels [1.2.1]. As the condition progresses, combination therapy becomes a common strategy. A Danish study following patients from 2000 to 2020 found that polypharmacy (using five or more medications) is now the norm for those with type 2 diabetes, with nearly 90% of patients having used five or more medications concurrently at some point [1.8.2, 1.8.3]. This highlights the need to understand how different diabetes drugs, such as Januvia and Jardiance, work together.

What is Januvia (Sitagliptin)?

Januvia, with the active ingredient sitagliptin, belongs to a class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors [1.3.1, 1.3.2]. It is an oral medication taken once daily to improve glycemic control in adults with type 2 diabetes [1.4.1].

Mechanism of Action

Januvia works by blocking the DPP-4 enzyme. This enzyme's job is to break down incretin hormones like GLP-1 and GIP [1.4.1]. These hormones are released after a meal and play a key role in glucose regulation by [1.3.1, 1.4.1]:

• Increasing insulin synthesis and release from the pancreas when blood sugar is high.
• Lowering glucagon secretion from the pancreas, which reduces glucose production by the liver. By inhibiting the DPP-4 enzyme, Januvia increases the levels of these active hormones, helping the body to control blood sugar more effectively [1.4.1]. Januvia is generally considered weight-neutral, meaning it doesn't typically cause weight gain or loss [1.3.1].

What is Jardiance (Empagliflozin)?

Jardiance, with the active ingredient empagliflozin, is part of the sodium-glucose co-transporter 2 (SGLT2) inhibitor class [1.3.1, 1.3.6]. It is also a once-daily oral tablet used to lower blood sugar in adults and children aged 10 and older with type 2 diabetes. Additionally, Jardiance is approved to reduce the risk of cardiovascular death in adults with both type 2 diabetes and established cardiovascular disease, and to treat certain types of heart failure and chronic kidney disease [1.5.5, 1.5.6].

Mechanism of Action

Jardiance works independently of insulin pathways by targeting the kidneys [1.3.2]. It inhibits SGLT2, a protein that reabsorbs glucose back into the bloodstream. By blocking this protein, Jardiance causes excess glucose to be removed from the body through urine [1.3.1, 1.5.4]. This process not only lowers blood sugar but also has additional benefits, including modest weight loss and a reduction in blood pressure [1.3.1, 1.6.2].

Can Januvia and Jardiance Be Taken Together?

Yes, healthcare providers may prescribe Januvia and Jardiance together [1.2.1, 1.2.2]. Since they have different and complementary mechanisms of action, using them in combination can offer improved glycemic control compared to using either medication alone [1.2.4, 1.7.5]. There are no known drug interactions between Januvia and Jardiance themselves [1.2.6].

Benefits of Combination Therapy

Studies show that combining a DPP-4 inhibitor like Januvia with an SGLT2 inhibitor like Jardiance can be an effective treatment strategy, particularly when metformin alone is not sufficient [1.6.2]. Key benefits include:

• Improved Glycemic Control: The dual mechanisms attack high blood sugar from two different angles—one by enhancing the incretin system and the other by excreting excess glucose—leading to greater reductions in HbA1c and fasting plasma glucose [1.7.1, 1.7.4].
• Cardiovascular and Renal Benefits: Jardiance has proven benefits in reducing risks associated with heart and kidney disease, an advantage that is retained when used in combination therapy [1.3.4, 1.5.5].
• Weight Management: Jardiance can contribute to weight loss, which is a significant benefit in managing type 2 diabetes [1.3.1]. Januvia is weight-neutral, so the combination can assist with weight management goals [1.3.1].

Potential Risks and Side Effects

While generally safe, combining these medications means being aware of the potential side effects of both. It's crucial to discuss these with a doctor. The combination does not typically increase the risk of hypoglycemia (low blood sugar) on its own, but the risk can increase if taken with other diabetes medications like insulin or sulfonylureas [1.2.1, 1.4.1].

• Jardiance-related risks: Increased risk of genital mycotic (yeast) infections and urinary tract infections (UTIs) due to increased glucose in the urine. It can also cause dehydration [1.3.2, 1.5.4]. A rare but serious side effect is Fournier's gangrene [1.5.4].
• Januvia-related risks: There have been postmarketing reports of acute pancreatitis, severe and disabling joint pain (arthralgia), and bullous pemphigoid (a skin reaction) [1.4.1].

Dosage adjustments for Januvia may be necessary for patients with kidney problems, whereas Jardiance may be stopped if kidney function is severely impaired [1.3.1, 1.4.4].

Comparison: Januvia vs. Jardiance

Feature	Januvia (Sitagliptin)	Jardiance (Empagliflozin)
Drug Class	DPP-4 Inhibitor [1.3.1]	SGLT2 Inhibitor [1.3.1]
Mechanism	Increases insulin release and decreases glucose production by the liver via the incretin system [1.4.1].	Removes excess glucose from the body through urine by blocking reabsorption in the kidneys [1.3.1].
Primary Use	Lowers blood sugar in adults with type 2 diabetes [1.4.1].	Lowers blood sugar in adults and children (10+) with type 2 diabetes [1.5.5].
Other Uses	None [1.3.4].	Reduces risk of cardiovascular death, heart failure, and chronic kidney disease [1.5.5].
Weight Effect	Weight-neutral [1.3.1].	Associated with modest weight loss [1.3.1].
Key Side Effects	Nasopharyngitis, headache. Rare risks of pancreatitis and severe joint pain [1.4.1].	Urinary tract infections, genital yeast infections, increased urination [1.5.4].

Conclusion

Combining Januvia and Jardiance is a recognized and often effective strategy for managing type 2 diabetes, leveraging two distinct mechanisms to improve blood sugar control [1.2.1, 1.2.4]. This combination can lead to better glycemic outcomes, potential weight loss, and cardiovascular benefits from Jardiance [1.6.2]. However, patients must be aware of the combined side effect profiles and maintain open communication with their healthcare provider to ensure the treatment is both safe and appropriate for their individual health needs, particularly concerning kidney function [1.2.1, 1.3.1]. There is no single-pill combination of Januvia and Jardiance, but other combination pills containing a DPP-4 inhibitor and an SGLT2 inhibitor exist [1.2.1].

For more detailed information, consult the official prescribing information on the U.S. Food & Drug Administration (FDA) website.

• JANUVIA® (sitagliptin) tablets Prescribing Information

Frequently Asked Questions

What is the main difference between how Januvia and Jardiance work?

Januvia is a DPP-4 inhibitor that works by increasing levels of incretin hormones, which helps the pancreas release more insulin and tells the liver to produce less sugar [1.4.1]. Jardiance is an SGLT2 inhibitor that works in the kidneys to remove excess sugar from the body through urine [1.3.1].

Is there a single pill that combines Januvia and Jardiance?

No, there is not a single medication that combines sitagliptin (Januvia) and empagliflozin (Jardiance). However, other combination drugs exist that pair a DPP-4 inhibitor with an SGLT2 inhibitor, such as Steglujan (sitagliptin and ertugliflozin) [1.2.1].

Does taking Januvia and Jardiance together increase the risk of low blood sugar (hypoglycemia)?

On their own, this combination has a low risk of causing hypoglycemia. However, the risk increases if you also take other diabetes medications known to cause low blood sugar, such as insulin or sulfonylureas. Your doctor may need to adjust the doses of your other medications [1.2.1, 1.4.1].

Can taking Jardiance and Januvia help with weight loss?

Jardiance is associated with modest weight loss, while Januvia is considered weight-neutral [1.3.1]. Therefore, the combination may contribute to some weight loss, primarily due to the effect of Jardiance.

What are the most common side effects of taking Januvia and Jardiance together?

The most common side effects would be a combination of both drugs' profiles. For Jardiance, this includes urinary tract infections and genital yeast infections [1.5.4]. For Januvia, common side effects are upper respiratory tract infections and headaches [1.4.1].

When is the best time of day to take Januvia and Jardiance?

Jardiance is recommended to be taken once daily in the morning, with or without food [1.5.1]. Januvia can be taken once daily at any time, with or without food [1.4.1]. For convenience, many people take them together in the morning, but you should follow your doctor's specific instructions [1.2.1].

Do I need to monitor my kidney function on these medications?

Yes. Assessment of renal function is recommended before starting and periodically during treatment with both medications [1.4.1, 1.5.1]. The dosage of Januvia may need to be adjusted based on kidney function, and Jardiance may not be suitable for those with severe kidney impairment [1.3.1, 1.4.4].