Key takeaways:
Januvia (sitagliptin) is usually safe and tolerated well. But in some cases, especially among older adults or those with kidney problems, it can put extra strain on the kidneys.
Reduced kidney function can raise the risk of side effects from Januvia. Because your kidneys clear Januvia from your body, the medication can build up if they aren’t working well.
In rare cases, people have experienced sudden kidney injury while taking Januvia. The good news is that kidney function improved after they stopped taking it.
If you have kidney problems, your healthcare team can keep an eye on your kidney function over time and adjust your dose to help you take Januvia safely.
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Many medications are available to treat Type 2 diabetes. Alongside popular injectable medications, there are several types 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.
While Januvia helps lower blood glucose (blood sugar) levels, you may wonder about its possible side effects. Kidney problems are one side effect that’s often of particular concern.
Overview: Januvia uses and dosages
Januvia is an oral prescription medication that’s FDA approved to treat Type 2 diabetes in adults. It belongs to a class of medications called dipeptidyl peptidase-4 (DPP-4) inhibitors — also known as “gliptins.” Januvia is used to manage blood sugar levels alongside a nutritious diet and routine exercise.
In general, Januvia is taken once daily. It’s available as a brand-name-only tablet and comes in three 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.
How does Januvia impact your kidneys?
In general, Januvia isn’t bad for your kidneys. But 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 such as older age, unmanaged diabetes, and persistent 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 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 professionals typically check urine or blood tests to assess kidney function before prescribing Januvia. They should 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 and symptoms 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 sugar is too high, and glucagon is released when your blood sugar is too low. Both of these hormones have a big impact on diabetes management.
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 several 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 cases 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 Januvia side effects 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 you manage or prevent Januvia side effects?
While most Januvia side effects are mild, there are ways to help prevent and 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 trying 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) such as ibuprofen (Advil, Motrin)
Diuretics (water pills) such as furosemide (Lasix)
Aminoglycoside antibiotics such as tobramycin
Osteoporosis medications such as zoledronic acid (Reclast)
It’s helpful to tell your prescriber 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 them 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 hemoglobin A1C (HbA1c or A1C) by about 0.7%. Your A1C is a measure of your blood sugar levels 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 sugar (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 prescriber should assess your kidney health 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.
Frequently asked questions
There aren’t any foods you absolutely have to avoid while taking Januvia. But since it’s used to manage Type 2 diabetes, it’s a good idea to limit foods and drinks that can quickly raise your blood sugar. This includes sugary beverages, desserts, and large portions of pasta or white rice. Alcohol should also be used with caution since it can raise the risk of low blood sugar, among other effects.
When it comes to kidney health, Jardiance (empagliflozin) is generally considered more protective than Januvia. Jardiance belongs to a group of medications called sodium-glucose cotransporter-2 (SGLT2) inhibitors. Large clinical studies have shown that SGLT2 inhibitors can help slow the progression of chronic kidney disease and lower the risk of kidney-related complications in certain people. Januvia may offer modest kidney benefits, but current trials haven’t shown clear, consistent improvements in kidney outcomes. That said, keep in mind that Januvia and Jardiance haven’t been directly compared in a dedicated kidney trial.
Januvia is meant to be taken long term to help manage Type 2 diabetes. There’s no set time limit. Many people take it for years, as long as it continues to keep their blood sugar within target range and doesn’t cause troublesome side effects.
There aren’t any foods you absolutely have to avoid while taking Januvia. But since it’s used to manage Type 2 diabetes, it’s a good idea to limit foods and drinks that can quickly raise your blood sugar. This includes sugary beverages, desserts, and large portions of pasta or white rice. Alcohol should also be used with caution since it can raise the risk of low blood sugar, among other effects.
When it comes to kidney health, Jardiance (empagliflozin) is generally considered more protective than Januvia. Jardiance belongs to a group of medications called sodium-glucose cotransporter-2 (SGLT2) inhibitors. Large clinical studies have shown that SGLT2 inhibitors can help slow the progression of chronic kidney disease and lower the risk of kidney-related complications in certain people. Januvia may offer modest kidney benefits, but current trials haven’t shown clear, consistent improvements in kidney outcomes. That said, keep in mind that Januvia and Jardiance haven’t been directly compared in a dedicated kidney trial.
Januvia is meant to be taken long term to help manage Type 2 diabetes. There’s no set time limit. Many people take it for years, as long as it continues to keep their blood sugar within target range and doesn’t cause troublesome side effects.
The bottom line
Januvia (sitagliptin) 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 team can tell you if Januvia is safe for you.
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References
American Diabetes Association. (2025). 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2026. Diabetes Care.
Coppolino, G., et al. (2018). Exploring the effects of DPP-4 inhibitors on the kidney from the bench to clinical trials. Pharmacological Research.
Dallumal, R. M., et al. (2015). Sitagliptin: Is it effective in routine clinical practice? International Journal of Endocrinology.
Feingold, K. R. (2025). Oral and injectable (non-insulin) pharmacological agents for the treatment of Type 2 diabetes. Endotext.
Merck Sharp & Dohme. (2024). Januvia [package insert]. DailyMed.
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. (2023). Dialysis.
You and Your Hormones. (2021). Glucagon.
You and Your Hormones. (2021). Insulin.
You and Your Hormones. (2021). Pancreas.
