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Managing type 2 diabetes often requires multiple medications to achieve optimal blood sugar control. Maintaining glycemic control is essential, as high blood sugar (hyperglycemia) significantly increases the risk of disease progression and vascular complications.

A large real-world study of over 130,000 patients newly diagnosed with type 2 diabetes found that 10-12% started treatment with a combination of two medications from the beginning, rather than following the usual step-by-step approach.

Two commonly prescribed drugs, Januvia (sitagliptin) and Jardiance (empagliflozin), work in different ways to help regulate blood sugar. But can they be used together? This article explores their effectiveness, potential risks, and what research says about combining them.

Key Takeaways

  • The distinct mechanisms of Jardiance and Januvia make them suitable for combination therapy in some cases.
  • Research shows that using Januvia and Jardiance together results in greater reductions in HbA1c, fasting blood sugar, and post-meal glucose levels compared to using either drug alone.
  • Jardiance has proven heart and kidney benefits, reducing the risk of complications in diabetes patients. Combining it with Januvia can provide broader metabolic health improvements.
  • While Januvia has a mild effect on weight, Jardiance leads to more noticeable weight loss. Together, they may support better weight control, which is vital for diabetes management.
  • People with advanced kidney disease, a history of pancreatitis, recurrent infections, or those at risk of dehydration should avoid taking Jardiance and Januvia together due to potential health risks.

What is the Difference Between Jardiance and Januvia?

Januvia (sitagliptin) belongs to a class of medications called DPP-4 (dipeptidyl peptidase-4) inhibitors. It helps the body control blood sugar by boosting natural hormones that increase insulin release, a hormone that lowers blood sugar, while reducing glucagon, a hormone that raises blood sugar.

In contrast, Jardiance (empagliflozin) falls under the SGLT2 (sodium-glucose co-transporter 2) inhibitor class. It lowers blood sugar by preventing the kidneys from reabsorbing glucose, causing excess sugar to be excreted through urine.

Because they work differently, their side effects also vary. Common side effects of Januvia include upper respiratory tract infections, nasopharyngitis, and headaches. Meanwhile, Jardiance is more likely to cause increased urination, urinary tract infections, and yeast infections.

Can You Take Januvia and Jardiance Together?

Patient holding several white tablets in hand

Yes, Januvia and Jardiance can be taken together, but this combination is not typically a first-line treatment. Their complementary mechanisms improve blood sugar control without overlapping effects.

It is prescribed under medical supervision, considering factors such as kidney function, heart health, and potential side effects, including dehydration and urinary tract infections associated with Jardiance.

For individuals with advanced type 2 diabetes, combination therapy is often necessary to maintain stable blood sugar levels. In some cases, patients may require three or more medications, particularly if complications like diabetic nephropathy have already developed.

Clinical Evidence Supporting Their Combination

Several clinical trials have evaluated the combination of Jardiance and Januvia for treating type 2 diabetes.

One study tested whether taking Januvia and Jardiance together would cause any significant drug interactions. The results showed no significant drug interactions, meaning their combination did not alter how the body absorbs or processes either medication.

Both drugs were well tolerated, and no participants experienced serious side effects while taking them together.

Another research assessed the effectiveness and safety of triple therapy with metformin, Januvia, and Jardiance in people newly diagnosed with type 2 diabetes who had not previously taken diabetes medication.

The study’s findings reveal:

    • Blood sugar levels dropped significantly, from 11.0% to 7.0% on average.
    • After 12 months, 72.5% of patients reached their target blood sugar level (HbA1c less than 7.0%), and after 24 months, 61.7% maintained it.
    • Insulin function improved, meaning the body used insulin more effectively.
    • Body composition improved:
      • Fat percentage decreased by 1.08%
      • Muscle percentage increased by 0.97%
    • Liver and kidney function improved, with reductions in fatty liver markers and albuminuria (a sign of kidney damage).
    • Ketone levels were initially high but normalized over time.
    • No serious side effects, such as ketoacidosis or severe hypoglycemia, were reported.

Other studies have also explored different DPP-4 and SGLT2 inhibitors combinations, further supporting their use in diabetes management.

Fun Fact!

Several single-pill combinations of DPP-4 inhibitors and SGLT2 inhibitors are approved for treating type 2 diabetes. Examples include:

    • Glyxambi: A combination of empagliflozin and linagliptin. Approved in the US in February 2015.
    • Qtern: A combination of dapagliflozin and saxagliptin. Approved in the US in February 2017.
    • Trijardy XR: A triple-combination pill that contains empagliflozin (Jardiance), linagliptin (Tradjenta), and metformin. It provides the benefits of three medications in a single tablet and was FDA-approved in January 2020.

These combinations simplify diabetes treatment by reducing the number of pills a patient needs to take, which may improve medication adherence.

Benefits of Taking Januvia and Jardiance Together

This combination therapy offers several benefits for individuals with type 2 diabetes, such as:

1. Enhanced Blood Sugar Control

Since they target different pathways, their combined effect leads to more stable and consistent blood sugar control. A 2018 meta-analysis showed that patients who took both medications had better blood sugar control than those who took only a DPP-4 inhibitor with a placebo. On average, their HbA1c levels dropped 0.59% more.

The combination also reduced fasting blood sugar levels, which is the amount of sugar in the blood after several hours without eating. Patients in the combination group saw their fasting blood sugar drop by 26.9 mg/dL.

Additionally, this therapy also helped control blood sugar after meals. Three studies found that post-meal blood sugar (2-hour postprandial glucose or PPG) decreased by 41.4 mg/dL in patients taking both medications.

Researchers found that patients who took both medications were 1.9 to 2.0 times more likely to reach the recommended HbA1c target than those who only took a DPP-4 inhibitor with a placebo.

2. Cardiovascular and Kidney Benefits

The leading cause of morbidity and mortality in patients with type 2 diabetes is cardiovascular disease. Fortunately, Jardiance has been shown to provide significant cardiovascular and kidney benefits.

In the EMPA-KIDNEY study, Jardiance lowered the risk of worsening kidney disease or cardiovascular-related death by 28%.

When paired with Januvia, this combination offers a comprehensive approach to improving heart, kidney, and metabolic health in patients with diabetes.

3. Weight Management Support

Weight management is an important consideration in diabetes treatment. Both Januvia and Jardiance may contribute to modest weight loss, whether used alone or in combination.

Studies indicate that Januvia typically results in a small weight reduction of 2-4 lbs. At the same time, multiple studies confirm that Jardiance leads to more significant weight loss, with an average reduction of 8.8-11 lbs over time.

Potential Risks and Considerations

Medication Side Effects

While taking Jardiance and Januvia together can offer benefits, there are also potential risks and considerations. These include:

1. Urinary Tract and Genital Infections

Jardiance increases the amount of glucose in the urine, which can lead to urinary tract infections (UTIs) or genital infections, such as yeast infections.

In a real-world observational study, patients using SGLT2 inhibitors were 3.7 times more likely to develop a UTI than those taking other diabetes medications, with 33.03% of Jardiance users experiencing a UTI.

2. Dehydration and Electrolyte Imbalance

Jardiance increases fluid loss through urination, which may lead to dehydration if fluid intake is not sufficient. This risk is higher in older adults and individuals taking diuretics.

Excessive urination can also deplete essential electrolytes, such as sodium, potassium, and magnesium, potentially causing imbalances. When electrolyte levels drop too low, various symptoms can arise:

    • Low sodium (hyponatremia) can result in confusion, headaches, and fatigue.
    • Low potassium (hypokalemia) may cause muscle weakness, cramps, or irregular heart rhythms.
    • Low magnesium (hypomagnesemia) can contribute to muscle spasms and an increased risk of arrhythmias.

Staying hydrated and monitoring electrolyte levels can help reduce these risks.

3. Pancreatitis

Post-marketing reports indicate cases of acute pancreatitis associated with Januvia, including both fatal and non-fatal hemorrhagic or necrotizing pancreatitis.

One study found that patients taking Januvia were 1.59 times more likely to be hospitalized for pancreatitis compared to those who never used it. The risk was highest during the first 9.5 months of treatment, with Januvia users 8.1 times more likely to develop pancreatitis than non-users.

While Jardiance is not commonly associated with pancreatitis, there is a growing number of case reports linking SGLT2 inhibitors, including Jardiance, to acute pancreatitis.

4. Hypoglycemia

While neither Januvia nor Jardiance directly causes low blood sugar, the risk increases if they are used together, especially if combined with insulin or sulfonylureas (e.g., glipizide, glyburide). Symptoms of hypoglycemia include dizziness, shakiness, sweating, confusion, and, in severe cases, unconsciousness.

Other Considerations Before Taking Jardiance and Januvia Together

Before combining Jardiance and Januvia, several factors should be weighed carefully:

Who Might Benefit from This Combination?

This combination may be beneficial for:

    • Individuals who require additional blood sugar regulation
    • Those with an elevated risk of heart or kidney complications
    • Patients unable to tolerate other diabetes treatments

Who Should Avoid This Combination?

Despite its benefits, this combination is not suitable for:

    • Individuals with a history of pancreatitis
    • Those prone to recurrent urinary tract or genital infections
    • Patients susceptible to dehydration or low blood pressure
    • People with severely compromised kidney function (eGFR <30 mL/min/1.73 m²)
    • Those using insulin or sulfonylureas
    • Individuals with advanced liver disease
    • Pregnant or breastfeeding individuals

Dosage and Administration

Jardiance and Januvia are taken separately, with doses tailored to an individual’s kidney function, overall health, and therapeutic needs.

A standard regimen typically includes:

    • Jardiance: 10-25 mg once daily
    • Januvia: 25-100 mg once daily

Adjustments may be necessary based on kidney function. Both medications can be taken with or without food, but adhering to a healthcare provider’s guidance ensures optimal effectiveness.

Cost and Insurance Coverage

As brand-name medications, Jardiance and Januvia can be costly without insurance. Prices vary by pharmacy and region, but general estimates in the US are:

    • Jardiance (10 mg or 25 mg, 30 tablets): $570-$650 per month
    • Januvia (100 mg, 30 tablets): $550-$600 per month

Without insurance, the combined monthly cost ranges from $1,100 to $1,250. Exploring manufacturer discount programs or lower-cost alternatives may help reduce expenses.

Get Your Diabetes Medications from Pharma Giant!

If you’re searching for a more affordable way to access Jardiance and Januvia, Pharma Giant, a trusted online Canadian pharmacy partner, provides a cost-effective and convenient solution.

At Pharma Giant, Jardiance starts at $139, and Januvia starts at $144–that’s over 70% off the typical retail price in the US. Save even more with coupons, bulk orders, and an exclusive 10% discount for new customers using the code PGSAVE10.

Final Thoughts

Taking Januvia and Jardiance together can be an effective approach for managing type 2 diabetes, particularly for those seeking improved blood sugar control with added cardiovascular benefits. However, like any medication regimen, this combination requires careful monitoring to minimize risks.

If you’re considering these medications together, consult your healthcare provider to determine if this approach is right for your specific needs. Regular monitoring of blood glucose, kidney function, and potential side effects will help ensure safe and effective treatment.

Frequently Asked Questions

Yes, these medications can be used together under a doctor’s supervision. Jardiance, Januvia, and metformin target different aspects of blood sugar control, and their combination may enhance diabetes management.

Certain medications may interact with Jardiance, including diuretics, insulin, and sulfonylureas, which can raise the risk of dehydration or low blood sugar. NSAIDs and ACE inhibitors might affect kidney function when combined with Jardiance. Other SGLT2 inhibitors should also be avoided to prevent excessive effects. Always check with a healthcare professional before adding new medications.

Yes, Jardiance and Janumet (a combination of sitagliptin and metformin) can be prescribed together for better blood sugar control. However, there is a risk of side effects like dehydration, kidney issues, or low blood sugar. A doctor should assess whether this combination is suitable for you.

The best combination depends on individual health factors, but Jardiance is often used with metformin, DPP-4 inhibitors like Januvia, or GLP-1 receptor agonists like Ozempic for improved blood sugar control. Some patients may also benefit from adding insulin or sulfonylureas if additional glucose-lowering effects are needed. The right combination should be determined by a healthcare provider based on blood sugar levels and overall health.

While taking Jardiance, avoid excessive alcohol consumption as it can increase the risk of dehydration and ketoacidosis. High-sugar and high-carb foods can counteract the medication’s effects on blood sugar. It’s also recommended to limit processed foods high in sodium, which may worsen kidney function in some patients. Staying hydrated is essential, as Jardiance increases urine output.

Januvia and Jardiance are different types of diabetes medications, so they are not direct substitutes. Depending on your needs and medical history, a doctor may recommend switching, but the choice depends on individual factors like kidney function and risk of side effects.

Related Articles

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