Januvia diabetes treatment to lower blood sugar levels, side effects by Merck company
December 19 2015 by
Ray Sahelian, M.D.

Januvia (sitagliptin phosphate) tablets are the first diabetes treatment approved in a new class of drugs known as DPP-4 inhibitors that enhances the body's own ability to lower elevated blood sugar. Januvia is used daily to improve blood sugar levels in patients with type 2 diabetes, alone or in combination with two other commonly prescribed oral diabetes medications, metformin or a PPAR (peroxisome proliferator-activated receptor gamma) agonist, when either of these drugs alone, along with diet and exercise, don't provide adequate blood sugar control. Type 2 diabetes is the most common form of the disease, accounting for about 90 percent to 95 percent of all diagnosed cases of diabetes (21 million in 2005). In type 2 diabetes, the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary to take sugar, the basic fuel for cells, from the blood into the cells. Over time, high blood sugar levels can increase the risk for serious complications, including heart disease, blindness, nerve damage, and kidney damage. For a list of natural supplements used in blood sugar control, see diabetes.

Mechanism of action
Januvia is a prescription medication that prolongs the activity of proteins that increase the release of insulin after blood sugar rises, such as after a meal. Januvia does this by blocking an enzyme (dipeptidyl peptidase IV or DPP-IV) which breaks down these proteins, leading to better blood sugar control. Januvia won U.S. approval in October, 2006 to treat adults with type 2 diabetes. Januvia belongs to a new class of medicines called DPP-4 inhibitors that work by enhancing the body's own ability to lower blood sugar. It does not seem to weight gain, an advantage over some older diabetes treatments. Weight gain is considered an especially serious disadvantage, as patients who gain weight tend to stop taking their medications and as obesity is one of the leading causes of type 2 diabetes

Diabetes research
Januvia medication was examined in a total of 2,719 patients with type 2 diabetes, in studies lasting from 12 weeks to more than a year. Januvia was taken daily. Januvia improved blood sugar control when used alone or in diabetes patients not satisfactorily managed with metformin or a PPAR agonist.

Januvia side effects
The most common Januvia side effects in clinical studies were upper respiratory tract infection, sore throat, and diarrhea.
   Dr. Sahelian comments: I am cautious about prescribing newly approved drugs. I prefer to wait a few years to make sure there are no Januvia side effects of significance before exposing patients to a new drug. In the meantime, there are many other drugs and natural supplements that have been on the market longer, and I prefer to continue using them rather than Januvia. The email below mentions a Januvia side effect reported to us. Just because a drug is approved by the FDA does not make it immune to side effects that had not been reported previously. We learned with Vioxx that FDA can approve a drug that can later be found to have significant side effects. Januvia may turn out to be safe, but why take the risk?

Much like your site says, I am reluctant to try newly released medicines, as is my doctor to have me try them. However, in the case of Januvia we went for the exception. I had been on metformin for about 3 months. Prior to that, I was in Italy doing a great deal of walking. Due to severe arthritis in my feet, I was taking some medrol packs to reduce the pain. Upon return, I had my A1C checked. (An earlier A1C test had resulted in a reading of 6.1, and a fasting blood glucose level of slightly over 120. I was considered pre-diabetic. I have a significant family history of type 2 diabetes and am 60 years old.) My returning A1C was about 8.5 with a high blood glucose level. I started metformin, and with some exercise, had my A1c at 6.2 and fasting blood glucose level at <100 in three months. After a short time on Januvia, probably just enough to build up the proper level in my blood, I began having severe flu-like symptoms, disorientation and lightheadedness. It did not seem to affect my glucose level as monitored by me any better than metformin alone. Within a week, I was forced to stop Januvia due to the debilitating effects. I had become very cautious about driving due to a “spacey” feeling I experienced and one glass of red wine made the symptoms intolerable. This is just an FYI that you may wish to use with your patients. I’m going back to my standard of waiting until a drug has been on the market for several years before trying it. It seems that for me, metformin and exercise is all that I need at this point. By the way, I was 220 lbs when diagnosed and I am now 195 and still dropping through diet and exercise and metformin.
   We wonder how many other Januvia side effects will be reported in the future as more people use this new drug.

2009 - Merck & Co Inc's blockbuster diabetes drug Januvia may be linked to serious cases of inflamed pancreas or pancreatitis.

Januvia FDA approval
Januvia is manufactured by Merck and Co., Inc., Whitehouse Station, N.J. Januvia approval occurred in October 2006, and the FDA said the approval of Januvia meant also that this drug could be used either by itself or in combination with other drugs for blood sugar control.

Is the cost too high?
Pharmazie. 2013 Nov. Pharmacoeconomic analysis of DPP-4 inhibitors. Dipeptidyl peptidase-4 (DPP-4) inhibitors and other incretin-related drugs have attracted attention as antidiabetic agents, but they are expensive. The Japanese government has adopted a policy of reducing healthcare costs, and medical institutions must provide medical care while considering economic efficiency. This study was a comparative survey of the usage, treatment effectiveness, and cost of DPP-4 inhibitors. The subjects were patients prescribed DPP-4 inhibitors (sitagliptin, vildagliptin, and alogliptin) at Gifu Municipal Hospital

Emails
Q. I have been on Januvia for three weeks and to my surprise, no side-effects, none, zippo, zilch. What a pleasant surprise. When I was on Byetta, oh man, the flatulence was so bad I had to stop using Byetta.

I am 63 years old and have been diabetic for more than 20 years. I was extensively exposed to Agent Orange over a two-year period while serving in Viet Nam. During an eight-month period while in the Rung Sat Special Zone I was subjected to extremely high doses of Agent Orange. I began taking Januvia about one month ago. Prior to that time I had been on metformin for several years. My fasting blood sugar level varied widely, from 140 to 100. I have not been able to control the blood sugar despite heavy exercise. Prior to taking Januvia I had non-healing small sores on my upper arms and above my clavicles. These sores are no more than 1/4" and seem to come and go. I have never had a sore at any other spot. Within 3 weeks of beginning a course of Januvia treatment I have developed a very different type of open wound (sore) on two places on the top of my left foot. Both are bothersome and despite applying 3-in-1 antibiotic are not healing. I have reported this to my attending physician.
   It is difficult to say whether these sore are related to Januvia unless many other users experience the same side effects.

Q.  Since I started using Januvia drug, and I have been a little reluctant to take it.....but ...I have noticed I am having sinus problems. The worst problem that I believe may come from Januvia are red spots on my legs. I had the PAD test to make sure I was okay in the area. I was okay. These red spot are getting worse. They are under the skin. I have make sure that I only take Avalide and Januvia, no herbals, nothing. Is there any way to check out this Januvia drug and find out if anyone else is having this problem?
   A. You may wish to do a google search using the words Januvia and skin. When two drugs are combined, in your case Avandia and Januvia, it is difficult to tell if one drug is making the symptoms or side effects of the other drug worse.