Lots of press recently about Merck’s brand spankin’ new Type 2 diabetes drug, Januvia. Patients seem to like it. The EU likes it. So Wall Street likes it, too. What is so wonderful about this new oral with the Shakespearean name?
Here’s what I found out, explained from my extremely laymen’s point-of-view:
In addition to insulin, our bodies release certain “incretin hormones” called GLP-1 and GIP. In a healthy body, the ideal amount is released from your gut in response to the amount and type of food you ingest. The role of these hormones is to “increase insulin response to a meal” by suppressing glucagon release (which is good, since glucagon’s job is to raise your blood glucose). In people with Type 2 diabetes, GLP-1 and GIP levels are below normal, and — big AND — they are intercepted by an enzyme called DPP-4.
This is where Januvia (sitagliptin) comes in. It works to inhibit the DPP-4 that breaks down the GLP-1 and GIP. Got that?
So far, the only other drug on the market that aids (or rather mimics) the action of GLP-1 is Byetta, aka exenatide, which over 500,000 people are now taking, according to authorities. (Not counting Januvia’s up-and-coming rival from Novartis, called Galvus — currently still under FDA review).
In a nutshell, these drugs are part of an emerging class of “incretin-based” therapies that block the DPP-4’s destructive function, allowing the incretins to live a long and happy life –- and hopefully fulfill their mission of recharging the beta cells. What this means for patients is better regulation of BG levels, since the incretins trigger beta cell insulin secretion and impede glucose production by the liver.
Still, I had to ask, why is so much better than all the therapies we’ve already got? It appears Januvia trumps all the others in terms of “tolerability,” meaning you feel better on it, don’t gain weight, don’t tend to go low (hypoglycemia), and don’t experience indigestion, heart problems, or swelling. Oh joy! And this translates into less troubles for Merck, of course, with fewer patients calling to complain 
To lay it on the table, here’s a rundown of the drawbacks of most Type 2 diabetes drug choices. Read ‘em and weep:
• sulfonylureas (Glipizide, Glyburide) – can cause hypoglycemia, weight gain, and gastrointestinal (GI) distress
• metformin – can cause mild nausea, diarrhea, and gas (aka GI distress)
• TZDs (thiazolidinediones, ie. Actos, Avandia) – can cause weight gain, swelling, and congestive heart failure
• insulin – can cause weight gain and hypoglycemia
So now you want Januvia, right? ah! There is one drawback: The pricetag! Currently over $4 per pill without insurance, and reimbursement is still up in the air. Well… just think of all the money you’ll save on Weight Watchers and Rolaids.
My doctor changed me from Metformin to Glyburide about 10 months ago. Over the last 25 years, I had lost 140# and had kept it off for 8 years. Since the glyburide, I have gained 30#. Is there anyone out there who has solved the weight gain problem while still on gluburide?
The doctor says I can’t go back on metformin (which I had been on for about three years) because of the chance for kidney damage. I really would like to understand these problems better.
My mother, 90 started on Januvia about 8 months ago and her memory has gone downhill drastically. Anyone had the same reaction to it?
I’ve been taking Januvia for about 6 months and am ready to stop. It gives me very little blood sugar control and is causing lots of edema, especially in my legs and feet.
Elderly male with metabolic syndrome (borderline BP, chol, trigly, etc but no weight prob) Diagnosed with insulin resistance /type-2 db 14 yrs ago. Been on glyburide/glucophage combin with increasing dosages (near max now). A1C stayed 250. ADDED Januvia to therapy mix 3 days ago. 100mg before dinner at night. Severe hypoglycemia following dinner (bg<70). But no effect on next day PP — still above 200.
Switched to 50mg morn and 50 mg evening — not much change. Still high daytime bg and hypoglc after dinner.
(High carb-vegetarian diet)
Correction. A1C stayed >7.5 (and bg >250).
I began taking Januvia last week to help regulate blood sugar swings. Within the first week I had a blister like rash appear on the tops of my forearms. I also have had sinus headaches and my blood pressure has increased. I have not felt well with the drug. I am a CFIDS sufferer for over two years and have improved some with the addition of vitamins and supplements and cutting out sugar (helped my immune system greatly). This med is taking me backwards. I have been aching like fibro patients which is something I usually do not do with my CFIDS. Not a good drug for CFIDS suferers.
Januvia has a PROFOUND impact on your immune system–it interacts with atleast 50 (known) proteins in the body! Look at what Merck has done lately: Vioxx, Vytorin–Januvia is next people!!! Check out the new warnings in their prescribing instructions–your docs have no idea about this!!! YOU ARE WARNED!!!
Has anyone experienced bladder infections using Januvia?
I have been on Januvia for 9 months and have recently developed a rash over my torso and legs. Has anyone else had this probloem?
I have been taking Januvia for four months. Could not take Metformin due to side effects. I take no other medications.
PROS:
Easy to take-once a day a.m.
CONS:
1. $ 40 copay
2. side effects:
leg aches/ mild swelling
difficulty with memory-recalling things
insomnia
My mother was on januvia in 2008 for about 3 months, after 2 months dr. increased dosage and 1 month later she got a rash on her abdomen. It end up it was patekia from low platelets because she had leukemia. I’m wondering how you are and if you found out what the rash was. I see Januvia cause pancreatic cancer, but don’t see anything about leukemia. Please reply. Thanks!
I was prescribed Januvia 100 mg daily along with simvastatin 20 mg and metformin 2000 mg daily for Type !! and choelestrol, but after 3 weeks my complete body went into pain. I was admitted to the hospital because they thought I was leading up to a heart attack but not true and was taken off simvastatin for my cholestrol immediately then I was told by doctors that my pain should vanish in 3-4 weeks but only left the upper portion of my body. I continued Metformin and Januvia as prscribed but the pain continued in the lower part of my body mainly my tail bone area & buttocks. I ‘ve seen seven different doctors including two pain management doctors which prescribed Epidural shots, (took 4) in my lower back no release from the pain made it worse. Then I went to another pain doctor , he prescribed oxycotin of 30mg 3 times daily and oxycodone if oxycotin did”nt take the pain away. and that helped a lot. That’s how severe my pain was, such as burning,stabbing, glass cutting, sitting on rocks 24 hours a day never ceased. After taking Januvia for 7 months I started thinking about when my pain started and decided to stop Januvia for 2 1/2 weeks now my pain is diminishing gradually. only taking 1 pain pain every other day or none at all. I got great results from the medications lower BS from 300 to about 80 -110 after fasting and 155 after meals, lost 38 lbs but the pain is not tolerable. I could not lay down, sit or stand in comfort for eight months pain constanly on a level of 10+ 24 hrs daily!!!!!!!!! Also I read on the side effects sheet from the pharmacy that Januvia could cause adorminal pain that leading to the back. I am reluctant to try again but if my BS goes up I wll try 1 every other day to see if it helps my BS.
Just read the study findings from the Larry L. Hillblom Islt Research Center at UCLA which shows that Januvia can cause pancreatitis, and, possibly, with long term use, pancreatic cancer. I was taking Januvia for over a year with not fabulous, but good results. The only side effect that I had was bad nausea after a medium to large meal. Now, I have stopped taking Januvia. I’d rather take my chances rather than die from pancreatic cancer.
I was so wondering about januvia, b/c everywhere I was looking kept saying that no one has had any weight gain with januvia…but then I typed in the right question and am finding out ppl are like me! I’ve been taking januvia & glucotrol for about a month and I have gained 12 pounds! THIS IS NOT GOOD! B/c I’ve always felt that that is what gets your diabetes under control,,,is significabt weight loss. Also I did notice that since I started taking these meds, I wake up with daily headaches, (already mentioned the weight gain) bloating in the upper area of my stomach, slight pains in the lower part of belly. So I’m very thankful for the ppl out there that are doing a lil research! About like I stopped taking the meds she gave me for BP (Lisinopril-which causes me to cough uncontrollably), I told them that I was taking GINGER ROOT 3X PER DAY and my BP stayed around 118/75-80! The Dr. wasnt happy about that! But I’m going back to it! Trying to find out what herbs & vitamins are great for lowering BS levels…but I gotta stop this!