Januvia

Januvia - How to take | Interactions | Effects

Januvia is a medication that contains sitagliptin and belongs to the group of inhibitors of dipeptidyl peptidase-4 (DPP-4). DPP-4 is an enzyme that breaks down glucagon-like peptide-1 (GLP-1). Inhibition of DPP-4 leads to an increase in levels of GLP-1, which lowers blood glucose level and have a number of protective effects. The function of GLP-1 is preserved in patients with diabetes mellitus type 2. This drug lowers HbA1c levels, stimulates insulin secretion and inhibits glucagon secretion. It can be used alone or in combination with other antihyperglycemic drugs for treating diabetes mellitus type 2.

Approximately 75% of this drug is excreted unchanged in the urine, while the remaining 25% is metabolized by the liver (via the enzymes CYP3A4 and CYP2C8).

Effects of this drug occur rapidly after oral administration and last for 12-24 hours.

Precautions

Studies have shown that Januvia has a low risk of hypoglycemia and has a neutral effect on body weight. Post-marketing studies indicate that DPP-4 inhibitors increase the risk of pancreatic cancer and pancreatitis, but European regulatory agencies have conducted the review of available data and haven't found a causal link between the use of this drug and pancreatic cancer. However, if you notice signs of pancreatitis (e.g. severe abdominal pain), you should contact your doctor immediately.

Since most of this drug is excreted in the urine via the kidneys, the dosage in patients with moderate or severe renal insufficiency need to be reduced.

Clinical studies have shown that Januvia is very effective, safe and well-tolerated drug.

Januvia, pregnancy and breastfeeding

AU TGA and FDA classified this drug to the group B since the animal studies in dosages that are 20-30 times higher than the maximum daily human dose showed that this drug does not increase the risk of adverse effects or malformations in the fetus. However, there are insufficient data regarding the safety of its use in humans during pregnancy.

Januvia is excreted in breast milk and therefore breastfeeding should be avoided while using this drug.

How to take

The usual dose in patients who have a normal renal function is 100 mg once daily.

In patients with creatinine clearance of 30-50 ml / min, dose should be reduced to 50 mg daily, while in those with creatinine clearance less than 30 ml / min, dose should be reduced to 25 mg daily.

There is no need for dose reduction in patients older than 75 years as well as in patients who have impaired liver function.

There is no data to demonstrate safety of this drug in patients younger than 18 years.

Swallow the pill whole with a glass of water, regardless of the meal.

Interactions

Januvia may enter into major interactions with the following drugs:

  • Bexarotene (a drug used for the treatment of skin lesions caused by cutaneous T-cell lymphoma). Concomitant use increases the risk of inflammation of the pancreas.
  • Gatifloxacin (an antibiotic). Concomitant use increases the risk of hypoglycemia.

It should not be used concurrently with the digoxin (a drug used for the treatment of heart failure), as the pharmacokinetic studies have shown that Januvia can increase the concentration of digoxin in the blood, which increase the risk of digoxin toxicity.

Drinking alcoholic beverages should be avoided because of an increased risk of hypoglycemia or hyperglycemia.

Side effects

Januvia may cause the following side effects:

  • Inflammation of the mucous membranes of the nose and pharynx (the so-called nasopharyngitis)
  • Hypoglycemia
  • Vomiting
  • Dizziness
  • Constipation
  • Respiratory tract infections
  • Inflammation of bones and joints
  • Pain in the extremities
  • Muscle pain
  • Joint pain
  • Back pain
  • Exfoliative dermatitis
  • Pancreatitis
  • Mild allergic reactions

References

  1. NCBI link 1
  2. NCBI link 2
  3. PIL