Many medications are available to treat Type 2 diabetes. Alongside injectable medications, there are currently 10 classes of oral medications. They each work in unique ways to help you meet and celebrate your health goals.
Januvia (sitagliptin) is one of these medications. It’s often recommended to be used alongside mainstay medications like metformin. But while Januvia helps lower blood glucose (sugar) levels, you may wonder about its possible side effects. Kidney problems are one side effect that’s often of particular concern.
What is Januvia?
Januvia is an oral prescription medication that’s FDA approved to treat Type 2 diabetes. It belongs to a class of medications called dipeptidyl peptidase-4 (DPP-4) inhibitors — also known as “gliptins.” Januvia is used to control blood glucose levels alongside a healthy diet and routine exercise.
In general, Januvia is taken once daily. It’s available as a brand-name-only tablet and comes in three possible doses: 25 mg, 50 mg, and 100 mg. The target dosage is 100 mg once daily, but your dose may be lower if you have certain kidney problems.
A combination pill — Janumet (sitagliptin/metformin) — is also available for convenience’s sake.
Does Januvia affect your kidneys?
In general, Januvia isn’t bad for your kidneys. However, some people should use it with a little more caution.
Januvia can cause problems if your kidneys aren’t functioning as well as they could. Factors like older age, uncontrolled diabetes, and long-lasting high blood pressure are common reasons your kidneys may become less effective over time. Because Januvia is primarily removed from the body by your kidneys, Januvia levels can build up and lead to more intense side effects if your kidneys aren’t working well.
There have also been rare reports of Januvia contributing to worsening kidney function. This includes a few reports of acute kidney failure, sometimes leading to dialysis. Dialysis is a procedure that can help remove fluid and waste from the body when your kidneys aren’t able to. The good news is that after stopping Januvia, any kidney impairment usually returns to baseline levels.
For these reasons, healthcare providers usually check urine or blood tests to assess kidney function before prescribing Januvia. They’ll also monitor your kidney health while you’re taking it. If your kidney health declines, they’ll likely prescribe a lower dose of Januvia. Make sure to also watch for signs of worsening kidney function, such as lower urine volume, foamy urine, or lower back pain.
Does Januvia affect other organs?
It can. Januvia may affect your pancreas. The pancreas is an organ in your gut that produces hormones and enzymes (proteins) that aid in digestion. Two of these hormones are insulin and glucagon. Insulin is released when your blood glucose is too high, and glucagon is released when your blood glucose is too low. Both of these hormones have a big impact on diabetes control.
It doesn’t happen often, but one of Januvia’s potentially serious side effects is acute pancreatitis. This is when the pancreas becomes inflamed over a short period of time. If you think you have pancreatitis, you should stop taking Januvia and seek medical treatment right away. Acute pancreatitis usually goes away within a few days after plenty of rest and treatment with intravenous (IV) fluids, antibiotics, and a low-fat diet.
There have also been isolated reports of liver injury due to Januvia. These rare reports tend to resolve once the medication is stopped. Medications that are similar to Januvia have also been linked to rare cases of heart failure.
What are the other side effects of Januvia?
Januvia is generally well-tolerated. The most common symptoms reported in initial studies were common cold symptoms and headache.
Other Januvia side effects are less common, but they’re possible. Keep an eye out for joint and muscle pain, constipation, and unusual changes in your liver lab work.
How can I control or prevent Januvia side effects?
While most Januvia side effects are mild in nature, there are ways to help prevent or manage them.
For instance, common cold symptoms and headaches are generally temporary. They should go away with time or after stopping the medication. You can also consider over-the-counter medications to help relieve short-term symptoms as your body is adjusting to Januvia.
If kidney problems are a concern, it’s helpful to avoid other medications that may also harm your kidney health. Do your best to avoid or minimize exposure to medications that can cause direct damage to the kidneys, such as:
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin)
Diuretics (“water pills”) like furosemide (Lasix)
Aminoglycoside antibiotics like tobramycin
Osteoporosis medications like zoledronic acid (Reclast)
It’s helpful to tell your healthcare provider and pharmacist about all of the medications you’re taking and any health conditions you may have. And if you have any bothersome symptoms at any point, make sure to let your healthcare provider know as soon as you can.
So, is Januvia safe?
Yes. Januvia is effective and safe for most people. In clinical studies, Januvia has been shown to lower A1C by up to 0.7%. Your A1C is a measure of your blood glucose control over a 2- to 3-month time period. These A1C effects are greater when combined with a medication like metformin. It’s also generally well-tolerated and doesn’t cause weight gain or episodes of low blood glucose (hypoglycemia) on its own.
What’s more, even though Januvia has been connected to kidney problems in the past, it’s not a common concern. Many people don’t run into problems while taking Januvia — especially if the right safeguards are in place.
As a precaution, your healthcare provider should assess your kidney strength before you start taking Januvia (and recurrently thereafter). They may give you a lower dose if you’re at a higher risk for kidney-related side effects.
The bottom line
Januvia is a prescription medication that treats Type 2 diabetes. It’s generally safe and well-tolerated. There have been rare reports of worsening kidney function after starting Januvia, but these cases have been reversible.
If you have kidney problems, you should still be able to take Januvia. You may just need a lower dose and more frequent kidney function tests. Your healthcare provider can tell you if Januvia is safe for you.
Why trust our experts?
References
American Diabetes Association. (2022). 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2022. Diabetes Care.
Dallumal, R. M., et al. (2015). Sitagliptin: Is it effective in routine clinical practice? International Journal of Endocrinology.
Merck Sharp & Dohme LLC. (2022). Januvia [package insert].
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). LiverTox: Clinical and research information on drug-induced liver injury. LiverTox.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Treatment for pancreatitis.
National Kidney Foundation. (n.d.). Dialysis.
Rahman, M. S., et al. (2021). Role of insulin in health and disease: An update. International Journal of Molecular Sciences.
You and Your Hormones. (2021). Pancreas.
Zeigerer, A., et al. (2021). Glucagon's metabolic action in health and disease. Comprehensive Physiology.
