Endocrinologist Review of Januvia

Today we are going to talk about the Januvia.  We are going to talk about Januvia side effects, where to get Januvia coupon, and we will compare Januvia versus Trulicity, Januvia versus Ozempic, Januvia versus Tradjenta, Januvia versus Jardiance, Januvia versus glipizide and glimepiride. 

At the end of this article, you will have a pretty good idea of what Januvia is. You will know the Januvia side effects. Moreover, you will understand the efficacy of Januvia compared to other oral diabetic medications. Finally, you will find out where and how to get the Januvia coupons. We will give you tips on how to make the Januvia coupons work.

What is Januvia?

Januvia is an antidiabetic oral diabetes medication.  It works by increasing the availability of gastrointestinal hormones.  They help you make insulin right after you eat.  Diabetics are resistant to these hormones.  So, Januvia boosts these gastrointestinal hormones to help you make more insulin when you eat. Yet, it is only a mild to moderately effective drug. It can reduce A1c anywhere from 0.6 to 2% depending on the starting A1c.

What is the dosage of Januvia?

Januvia comes in 3 different doses.  It is available as 25 mg, 50 mg, and 100 mg dose.

Can it be used with kidney failure or chronic kidney disease?

Dosage adjustment will be necessary if you have kidney problems.  As long as doses adjusted Januvia can be used given in dialysis patients.

Can it be used with liver disease?

Yes, Januvia can be used with liver failure.  Januvia is not metabolized by the liver so it is safe.

Are there any generic Januvia available?

Unfortunately, generic Januvia is not available in the market.

What are the side effects of Januvia?

• The most common side effect is low blood sugar only if it is used with insulin or sulfonylurea agents. Sulfonylurea agents are glipizide, glyburide, glimepiride. Januvia in combination with metformin or by itself, Januvia is not a high-risk medication for low blood sugar.
• Sinusitis or pharyngitis are also relatively common. In my experience sinus problems are the most common side effects.
• Some people may report nausea or diarrhea.
• There are rare cases of acute pancreatitis, anaphylaxis, joint pains, back pain, constipation, headache. Some other side effects are limb pain, muscle pains, mouth ulcers, kidney failure, skin rash.
• Sometimes severe joint pains can happen with Januvia.  These joint pains may start within a day but also can happen years after treatment start. Hypersensitivity reactions such as severe skin rash anaphylactic shock can happen.

Is pancreatitis a common side effect of Januvia?

• There are reports of acute pancreatitis. Whether Januvia causes pancreatitis directly is not known. In my experience, this is a very rare side effect.
• Some of the pancreatitis cases led to ICU admission or even death.  However, this is very rare to happen.

Does Januvia cause pancreatic cancer?

Studies indicated a possible link between Januvia and pancreatic cancer. But, based on the current evidence and human studies there is no clear evidence to suggest Januvia causing pancreatic cancer. FDA alerts physicians for a possible association between Januvia and pancreatic cancer. In my practice if someone has pancreatic cancer in their first-degree family I do not use Januvia.

Can patients with bariatric surgery use Januvia?

Patients who had gastric bypass surgery in the past may have had less or more absorption of the medication.  After gastric bypass surgery, gastrointestinal hormone levels increase.  After gastric bypass surgery, Januvia's exposure may increase the exposure of gastrointestinal hormones significantly.  In some studies, Januvia was used after gastric bypass.  In that study, patients tolerated Januvia well.

Are there any drug interactions between Januvia and other drugs?

Yes, definitely there are a lot of medications that will interact with Januvia or change the efficacy of Januvia.  Your endocrinologist/diabetes doctor would know which medications you are on.  They may be able to adjust other medications to reduce the interaction with Januvia.

Can pregnant women use Januvia?

Although this is not well studied in my practice I do not recommend Januvia to a pregnant or lactating woman.

How much is Januvia?

Januvia can be very expensive if you are paying cash for it.  The typical price per 1 pill is around $17 to $19.

Are there coupons for Januvia?

Definitely there are coupons for Januvia.  If you are a Medicare or Medicaid patient you will not be able to take advantage of Januvia coupons.  If you are eligible you may pay as low as $5.  Having a coupon for Januvia is not always going to guarantee a reduction in out-of-pocket costs.  

There are many barriers starting from the physician prescribing the medication and pharmacists appropriately running the co-pay card.  In my experience for 1 or the other reason, a lot of pharmacies will reject coupons.  You will need to activate these coupons before you go to the pharmacy. 

You also need a pharmacist who cares about your out-of-pocket costs.  In my practice, we help patients get medications at the lowest cost.  We communicate with the pharmacists on behalf of patients if there is any problem running the coupons.

Let us compare Januvia to other oral antidiabetic medications

Januvia versus Trulicity

In head-to-head studies, Trulicity was almost twice more effective than Januvia. Trulicity is an injection once a week vs Januvia is an oral medication once a day. They are both brand medications so both the Januvia and Trulicity are expensive. Trulicity helps with weight loss and Januvia does not. Trulicity has more side effects with nausea, diarrhea, and constipation.

Januvia versus Ozempic

Ozempic is a very similar medication to Trulicity.  So the same comparison of Januvia versus Trulicity can be made between Januvia and Ozempic as well.  See above. Please refer to our Ozempic and Trulicity blogs. You will find detailed information about Ozempic and Trulicity efficacy. You will also find information about Ozempic and Trulicity side effects.

Januvia versus Jardiance/ Januvia versus Farxiga/Januvia versus Invokana

Jardiance, Farxiga, and Invokana are SGLT2 inhibitors and they work similarly. In terms of efficacy Januvia and Jardiance are similar to reduce blood sugars. Jardiance helps with weight loss and Januvia does not. Jardiance has data to prove that it reduces risk of death from cardiovascular causes.  Januvia does not have data. Januvia is neutral when he comes to the blood pressure.  Jardiance helps with blood pressure reduction.

Januvia versus glipizide/Januvia versus glimepiride/Januvia versus glyburide

Glipizide, glyburide and glimepiride are all sulfonylureas and do a similar job. Sulfonylureas are more effective than Januvia and lowering blood sugars although some studies indicate similar efficacy. Sulfonylureas are much cheaper than Januvia. The risk of very low blood sugars (hypoglycemia) is much higher with sulfonylurea versus Januvia. Sulfonylureas can cause weight gain. Januvia is weight neutral.

Metformin versus Januvia

Januvia is much more expensive than metformin. The efficacy of Januvia is similar to metformin and lowering blood sugars. Metformin can cause a slight weight loss whereas Januvia does not cause any weight loss. If started early metformin can help reduce heart attacks.  Januvia has no proven data.

My take on Januvia as an endocrinologist

In my diabetes practice, I do not prescribe Januvia too often.  I have a bias, as I generally see patients with uncontrolled diabetes.  Most of my patients will need more intensive or more effective therapies.  Januvia may be a good option for a newly diagnosed diabetic patient who has a significant fear of needles. 

Unfortunately, Januvia does not have a weight loss effect or any cardiovascular benefit.  Some other branded antidiabetic medications for type 2 diabetes has proven cardiovascular benefit and weight loss.  Due to that, the Januvia is at a disadvantage at this time in my practice. 

My goal is not only to control blood sugars but also reduce cardiovascular disease and help patients lose weight. Januvia can be handy in elderly patients who may not tolerate medications that can cause a weight loss or dehydration.  It can also be very effective medications for patients on dialysis.  Elderly nursing home patients generally respond well to Januvia especially if they were diagnosed with diabetes later in life.

The bottom line

Every patient is unique.  We will choose medications if at all necessary, based on specific patient needs.  This requires a detailed clinical understanding of the patient as well as an understanding of all the other diabetic medications in the market.  This helps us to determine what is best for the patient.  With the help of remote glucose monitoring, we can also identify if the medication is working within a few days instead of waiting 4 months to see the patient at the follow-up visit.

We help patients obtain Januvia coupons or any other medication coupons to help reduce out-of-pocket costs. Join us for us to evaluate your diabetes and find the best possible solution for you. We also help patients obtain medications if they are in financial aid. 

You will be surprised how many patients are actually a real candidate for financial aid even with income is up to $60-$80,000 a year. Please feel free to contact us directly for any questions or concerns. Author: Ahmet Ergin, MD, FACE, CDCES, ECNU About the author: Dr. Ergin operates a large diabetes practice mostly in Jupiter, FL, yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him to track patient progress and be available at all times.