Much Ado About Januvia: What It Doesn’t Do

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?Happy_pill_1

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.


118 Responses

  1. Marty
    Marty February 6, 2007 at 6:41 pm | | Reply

    Januvia is n picnic from the first time I took it felt as if I had a fever would shiver as if I was freezing after a week added getting dizzy to the mix spent the day in the hospital my enzymes were all messed up but got better as time went on within 2 days of stopping Januvia all symtoms went away.

  2. Steve
    Steve February 6, 2007 at 10:05 pm | | Reply

    Jeez! I want to know more about this stuff. I’m type 2, and really struggle with the weight thing. If this really helps, it would be great. I’m already full of the chills, so maybe I wouldn’t notice that side effect?

  3. mcityrk
    mcityrk February 6, 2007 at 11:38 pm | | Reply


    You might want to give David Kliff at Diabetic Investor Newsletter a call and see if he is willing to post his comparative notes on the Byetta vs Januvia question in the public domain. He discussed both the financial prospects and the patient care prospects for the two drugs in several recent emails to the subscribers of his newsletter-

  4. AmyT
    AmyT February 12, 2007 at 8:46 am | | Reply

    Hi mcityrk,
    Thanks for the tip on David Kliff. He’s an excellent resource.

  5. nancy
    nancy March 15, 2007 at 12:04 pm | | Reply

    When should you see a difference on your readings? I have been on januvia 1 week now and still readings are high.

    KATHLEEN STECKEL March 31, 2007 at 9:43 am | | Reply


  7. Claire Carley
    Claire Carley April 4, 2007 at 4:37 am | | Reply

    Please advise how quickly the Januvia worked for those of you who found it effective……is there a waiting period or is it more or less immediate?

    GEORGE HARRIS April 8, 2007 at 5:46 am | | Reply


  9. Pam
    Pam April 8, 2007 at 4:17 pm | | Reply

    I have been on Januiva since Feb. 12 of this year. So far it has worked for me. But I have expereniced the following side effects, headache (nearly every day), runny nose, nausea. I have the nausea more when I eat carb’s.
    I don’t tend to be hungry like I use to be.

  10. Gilbert
    Gilbert April 9, 2007 at 4:26 pm | | Reply

    Does anyone have a Medicare Insurance Policy that pays for Januvia? “Humana” let me have a one month quantity then cut it off even with my specialist requesting it for me? Seemed to work OK for the one month.

  11. Jenny B
    Jenny B April 11, 2007 at 3:53 pm | | Reply

    I got very good blood sugars with Januvia for 3 months. I too went off insulin 3 times a day. However, I noticed that cuts and finger sticks were taking longer to heal, I developed sinus headaches, and most importantly, when I started researching DPP-4 inhibition, I discovered that DPP-4 inhibition is known to promote the transformation of melanocytes into melanoma.

    I have not been able to get any doctor or researcher familiar with DPP-4 to explain to me why a drug that inhibits DPP-4 would be safe for someone who has had melanoma. They tell me that the only information available about Januvia is the information which the drug company publishes, and that completely ignores issues involving the effect of DPP-4 inhibition on the immune system which uses DPP-4 to heal wounds and especially on the part of the immune system that keeps DPP-4 sensitive cancers in check.

    I have reluctantly stopped taking it until I can get a better answer about the effects of DPP-4 inhibition on the rest of the body, not just GLP-1.

    It worked really well for me, though.

  12. Patricia Crystal
    Patricia Crystal April 20, 2007 at 9:44 am | | Reply

    I am very disciplined with diet and exercise and have lost 27 pounds since I was diagnosed with Type II on Feb 15th. I’m ready to stop taking Januvia. Is it dangerous to just stop taking Januvia or must I gradually reduce the one a day dosage?
    Thank you.

  13. Karen,  San Diego, CA
    Karen, San Diego, CA April 23, 2007 at 9:34 am | | Reply

    I had a headache every day after starting januvia. After 2 weeks, the headaches stopped but I now have upper respiratory symptoms: sneezing, runny nose. My BG is not improved and I have experienced swelling. I’ll hang in there for a month, but will re-evaluate then.

  14. Bill
    Bill April 23, 2007 at 1:14 pm | | Reply

    I’ve been on Januvia for a little over three months and have lost over 15 pounds which I had put on with Actos. I’ve experienced no side effects, other than I am not hungry all of the time. For me it has been very effective. Time will be the best measure of that though.

  15. Dusti
    Dusti April 24, 2007 at 3:05 pm | | Reply

    Byetta vs. Januvia–I took Byetta a year ago for about a month, and lost quite a bit of weight, but I got so nauseous I had to stop. I started Januvia about 6 weeks ago and have lost 5 pounds. I am not hungry like I used to be, but do not experience side effects others have mentioned. Since I reacted poorly to Byetta, and not to the Januvia, maybe it’s just my chemistry. I would say everyone is different, and while some may have adverse side effects, not everyone does. I noticed results pretty much immediately, and my numbers have stayed in good control. My insurance pays for part, but it’s still quite costly. I love not taking insulin anymore.

  16. Pam
    Pam April 26, 2007 at 6:03 pm | | Reply

    The last 2 weeks I have experienced some low blood sugar drops after I take the Januiva. I break out into a sweat and get dizzy. It usually happens anywhere from 1/2hour to 1 hour after I take the medicine. I eat usually after I take it. I am on 100mg a day. Usually happens in the morning and sometimes late in the afternoon.
    Has anyone else experienced low blood sugar’s?

  17. Tom Peck
    Tom Peck May 1, 2007 at 12:32 pm | | Reply

    Prior to taking Janvuvia my BS was in the 160 to 180 range. Now it has gone up into the 260 to 300 range. I feel OK but this can’t be right. Has any one else had this problem?

  18. Jo
    Jo May 1, 2007 at 8:55 pm | | Reply

    My BS was staying around 100 or lower with insulin; started januvia about 3 weeks ago and my BS is staying between 200 and 300. I am losing weight that I gained on insulin, but the BS just won’t come down. I have been very careful with my diet.

  19. Susan
    Susan May 3, 2007 at 1:18 pm | | Reply

    I started on Januvia about 3 weeks ago and my daily readings dropped from an average if 250-300, to daily averages of 150 or less. I haven’t noticed weight loss as of yet, but I’m hopeful. I am not as hungry. I was one step away from being put on insulin so I’m very hopeful this is the answer to avoiding it.

  20. Jim K L
    Jim K L May 5, 2007 at 10:38 am | | Reply

    Januvia has been a positive thing for me. My sugar levels dropped from 240+ to 110 +/- 10 after fasting. I have taken 100 mg once per day for a month. My insurance will not pay for it. I spend $170.00 per month on it. For the last 2 months, I have cut the tabs into 2 and the 50 mg dose seems to do the job. This cuts my cost to $85.00 per month. I have had left leg and ankle swelling, but ascribe it to using too much salt. I have had some headaches was well, but I think they come from the salt and resultant blood pressure rise. I seem to get tired and sleepy alot, but don’t know if it is sourced to Januvia, for I had theses problems before Januvia usage. I am not as hungry as before usage. The other products, like Gluburide, helped in my weight gain. Januvia, is it safe?
    If my blood sugar is not controlled will I keep my sight, feet, legs, life? Januvia seems to help. I know I am taking a chance on Januvia, but I had to do something drastic.

  21. Leticia Mkrtchyan
    Leticia Mkrtchyan May 17, 2007 at 10:09 pm | | Reply

    I’ve taken Januvia for about 5 months now and was off medication for nearly two years I’m 24 and at the time I didn’t have insurance. Januvia worked at first lower my blood sugar but I still felt tired. My doctor prescribed Provigil for me sort of an energy booster and it made me feel great after my 2 month ckeck up I’d lost 5lbs and my fasting blood sugar was 152 when I first went in fasting was 289. The only thing that makes me not want to work out are the sinus headaches and I get really nauseous when I eat carbs. Aetna select is the insurance I have now it cost me $20 for my month supply.

  22. Pam
    Pam May 19, 2007 at 1:39 pm | | Reply

    I’ve been on Januvia since Feb. 12th of this year. It has helped lowered my blood sugar readings.
    But I still have some major blood sugar drop’s where my sugar drops below 70. It has happened several times the last few weeks. I feel tired on the Januvia also.
    I also get nauseous after eating carbs.

  23. Justin Sanchez
    Justin Sanchez May 21, 2007 at 5:37 pm | | Reply

    Ive taking Glimipiride (Isipryl)It has worked for me, but Im afraid of the side effects that it could lead to heart failure.
    I have had no side of effects. I take 4mg a day. It has kept my blood levels under 129 to 110 fasting. Im thinking of switching to Januvia. because it supose to have very little side of effects.

  24. sandra
    sandra May 24, 2007 at 11:23 pm | | Reply

    i have been taking januvia, along with lantus and humulog for about four weeks. i have experienced chills which have now gone away, and sore throats which has improved but still occurs sometimes at night. the first night it was severe, i took a motrin and it got better. now it comes and goes at night. my bs is improving, but i feel overwhelmed having to take so much medicine. i want to stick with the januvia, but i will definitely monitor myself closely and continue to see my doctor which i have a visit with at the end of the month.i will be seeing an endocrinologist so that i can ask more questions. i feel that there is a solution in all of this and i will continue until i find it. everyone deserves to feel good as much as possible, and everyone should care enough to research. most doctors cant find the solution, but working together should produce a solution that you can hopefully live with. there are so many aspects to this disease. i have noticed that simply eating, and the i guess chemicals organic or otherwise, trigger reactions that can cause me to eat when i dont choose to. you might consider that as depression, but i dont exactly know, but it does. i sure we are all depressed at sometime or another dealing with this dis-ease,but i dont think that depression dictates my life, because i have a lot to live for and i want to experience all of it. if i went too far, please forgive me, i am merely expressing myself. peace

  25. s. coioper
    s. coioper May 25, 2007 at 7:47 pm | | Reply

    My mother wanted to stop her Januvia 2 days ago. Will she get sick now? She was having trouble breathing, sleeping and felt tightness in her chest. She is an 82 year old type II diabetic. Thanks Also her eyes have started wattering and she has to have surgery on one of them for fluid build up on th 4th of June 2007

  26. R Cowan
    R Cowan June 11, 2007 at 7:29 pm | | Reply

    I started taking Januvia in the fall of 2006 shortly after it was released. Initially I did well on the drug with improved glucose levels. However I began to struggle with asthma to the point where I was maxed out on inhalers and medications. I started reading about respirtory infections being a side effect of Januvia and as a last resort talked to my doctor and discontinued the use of Januvia. My asthma has improved to the point where I only need to use an inhaler occasionaly. Nothing else changed except for stopping the drug. Not certain what to make of that but do not plan on resuming taking Januvia. Anyone else experienced this? Thanks

  27. khan
    khan June 14, 2007 at 12:47 pm | | Reply

    I was going to start Januvia but after going through all the posts above, I am scared to try it. Looks like it does not help too many people. I would like someone’s opinion who has taken it for at least 6 months. Thanks

  28. Sue
    Sue June 15, 2007 at 3:10 pm | | Reply

    I started januvia 1 month ago. My number have come down somewhat in the beginning, but now I notice that they are not dropping to a normal level. I do experience very low readings 2-3 times per week for no reason….sometimes waking in the middle of the night with numbers in the 50-60′s…….

    Also have notice for the last 1 1/2 pain in my legs (muscle pain and heavyiness) just as I get from Cholesterol medications. I am going to stop it tomorrow and see what happens after 1 -2 weeks…

  29. Nancy
    Nancy June 16, 2007 at 5:27 pm | | Reply

    My dr. has prescribed Januvia as Actos did cause a slight weight gain and I was taking it 3 times a day. I have rebelled at taking any meds due to the fact I don’t believe my numbers are that high and I’ve never had any of the symptoms of diabetes although my dad and members of his family did have it. After reading some of the side effects I wonder if I want to “take the chance”. I would like to hear from more people who have taken it and had no side effects. I am over 75, keep active and try to eat healthy. I’ve heard a vegen diet can control diabetes without taking meds but drs. don’t give you info on these as they just want to write more prescriptions.

  30. sue
    sue July 5, 2007 at 12:04 pm | | Reply

    My last posting on 6-14 say it was posted by KAHN…however, I wrote the posting and my name is SUE…

    Anyway, I stopped Januvia on 6-15-07 and by 6-19 my leg pain was completely gone and has not returned.
    I am leary to restart, but will do so most likely on Monday of next week and see what happens after 4-5 weeks….if the pain returns, I am definetly off Januvia for good

  31. sue
    sue July 5, 2007 at 12:06 pm | | Reply

    I am reposting again as the web site is screwed up…I am now called Nancy…guess it doesn’t matter what my name is so here is the posting again…

    My last posting on 6-14 say it was posted by KAHN…however, I wrote the posting and my name is SUE…

    Anyway, I stopped Januvia on 6-15-07 and by 6-19 my leg pain was completely gone and has not returned.
    I am leary to restart, but will do so most likely on Monday of next week and see what happens after 4-5 weeks….if the pain returns, I am definetly off Januvia for good

  32. Sue Goodell
    Sue Goodell July 6, 2007 at 1:33 am | | Reply

    I started Januvia 1 month ago because of the Avandia scare with all the heart problems. My cardiologist wants me off the Avandia, and the Januvia was already lowering all my blood sugars by 40-50mg/dl. I stopped the Avandia and my sugars are still perfect.I have already stopped all the sliding scale insulin as it is now unnecessary. I’ve had a slight headache but am willing to put up with that because the threat of a heart attack from Avandia/Actos is worse. I am hoping the headache will resolve with time. So far I am ecstatic with the results. My appetite is significantly less and I am hoping to lose some weight be cause the previous increase in the use of sliding scale insulin had caused me to recently gain weight.

  33. R.Paul
    R.Paul July 8, 2007 at 9:02 am | | Reply

    After taking Januvia for about three months I have developed insomnia. Does anybody know whether this is a side effect of Januvia?

  34. sassie
    sassie July 8, 2007 at 11:25 am | | Reply

    I am told that there is a product combining Januvia and Glucophage. Anyone know the name, cost, effectiveness. Januva is not holding down my BS as well as Avandia did.

  35. G White
    G White July 10, 2007 at 8:50 am | | Reply

    I have been on Januvia for 4 months. I love it. I have not had any side effects. I have lost weight that was gained on gylburide. I do not have the low BS that I expericenced on other meds. My fasting BS are higher though. I usually ran 80-90 now it is 120 but 2 hrs after meals I am only 130-150 which is good for me. I am due for a HBgHCt so I hope for good results.

  36. Cliff
    Cliff July 10, 2007 at 9:42 pm | | Reply

    To answer the question posted 7/8/07 by R. Paul, the combined Januvia/Metformin product is called Janumet. It comes in two strengths, 50mg/500mg and 50mg/1000mg X2 daily(Januvia/Metformin). I started the 50/1000 x2 daily last week. I had been on Januvia for a month. My goal is to eliminate the Glipizide. I have been able to already reduce the Glipizide from 2x daily to 1x. So far so good….

  37. Ann Dean
    Ann Dean July 12, 2007 at 5:15 am | | Reply

    Actos does not cause heart attack and has kept my aic’s under 6.5

  38. Penny
    Penny July 12, 2007 at 1:37 pm | | Reply

    Hi, I was just prescribed Januvia this morning by my physcian. My BS have been off the chart for some time now even though I was on 8mg of Avandia and 6mg Amaryl. I have been under a lot of stress due to my son’s heart condition and my mother’s reoccurence of cancer, so I am hoping that is to blame for the increase in my BS. I tried Glucophage for over a week but the GI side effects nearly did me in. I too am hoping for good results with Januvia and I will post my results soon!!

  39. Beth Lambert
    Beth Lambert July 17, 2007 at 1:41 am | | Reply

    I took Junuvia this morning and bs have been running higher then on Avandia. Awakened at midnight sweating, blood sugar 187 dropped by 3 am to 147. Rose from bed with head dizzy almost fell. trouble sleeping. Debating whether to continue with this drug.

  40. Mike
    Mike July 17, 2007 at 5:43 am | | Reply

    I take Januvia and have for 6 months. I have no side effects. I have experienced a decrease in appitite. I have had no headaches or respiratory problems. My BS has gone down. It is a great drug.

  41. Julie
    Julie July 19, 2007 at 1:19 pm | | Reply

    Januvia seems to have raised my blood sugar to unacceptable levels. Although I was put on it because my numbers were too high, the Januvia seemed to raise them even higher, into the 300′s. Not good! Dr. told me to stop it for a few days and try it again. I did. Numbers dropped way down to 80 to 110, although I was still having some high numbers in the 200′s, particularly in the morning. I have restarted the Januvia this morning and will see how it goes.

  42. sue
    sue July 19, 2007 at 2:47 pm | | Reply

    I restarted januvia after off it for 3 weeks. I did not get the leg pains this time, but within the 1st 10 days I started to get the pains in the liver area. I know from past experiences with other drugs that this pain is inflammation of the liver….high liver count, so AGAIN, I have stopped januvia…Yes it did lower my numbers a bit but it also caused extremely lower numbers to the point of waking me in the middle of the night. Not sure I care for this, so I am now off it again and will callthe doc and see what he says…

  43. Earl
    Earl July 20, 2007 at 12:37 am | | Reply

    I have been on Januvia for approx 3 weeks now and so far it is great. I am substantially less hungry then I have felt in years (lost about 3-5 lbs so far) and my BS hovers around 100 – 120 between meals/fasting, and 120 – 160 for a few hours after a heavy carb meal. The usual BS spikes of 180 – 200+ are completely gone. I am still taking very low doses of Avadia and Metformin though, which I am sure is helping. As for side effects, I am actually feeling better now that my Avadia/Metformin (Avandamet) doses are less. I have noticed a slight chill within the first 2-3 hours of taking Januvia. But nothing significant.

  44. Roger
    Roger July 20, 2007 at 9:52 pm | | Reply

    I began taking Januvia in January, and began having mild headaches shortly thereafter. I have also noticed that when I walk on back-to-back-to-back days (about 3-4 miles/day), on the third day I have such upper leg and hip pain that I have to stop and rest occasionally. This never happened before Januvia. My BS readings were only in the 130-145 range when my physician put me on Januvia. I am redoubling my exercise and dietary efforts to lower it to the point where I can discontinue Januvia, because ALL DRUGS HAVE SIDE EFFECTS! They certainly don’t affect all people, but my goal is to get off them completely. It is indisputable that Type 2 diabetes can be controlled by diet and exercise alone. It’s simply a matter of paying the price, and I intend to.

  45. Stephen Parker
    Stephen Parker July 25, 2007 at 9:59 am | | Reply

    I have been taking Januvia for 3 months and have had tremendous results. I have leg pain, especially in the ankles, but only occasionally and can’t really attribute it to the medicine or older age (54). I also take Metformin twice a day and walk 4 miles per day. I think by reading all of the comments above, most of you are my age or older and should expect some of your problems as natural, or caused by a combination of drugs. Give Januvia a chance and don’;t assume that your side effects are always caused by Januvia. Sometimes the pain is lesser of two evils…certainly knowing the effects high blood sugar can have on your body over time.

  46. Larry Norred
    Larry Norred July 28, 2007 at 8:53 am | | Reply

    I have been taking Januvia for 2 months in addition to Humalog and Lantus and have no side effects to speak of and it has lowered my BG level by 100 points since day 1 on the drug. I have consciously chosen to not constantaly look for every possible horrible side effect and give the medicine a chance to work before condemning its use. If you only use it for a couple of days and condemn it, you are not giving it a fair chance to get into your system and work. There are lots of things that cause all these other sensations that you are all reporting. I’m sorry to the rest of you, but I’ve never had any medicine work as well as this product and I don’t have any horrible side effects to report except that it works really well.

  47. LT
    LT July 30, 2007 at 10:54 am | | Reply

    I recently began taking Januvia along with Avandamet and Metanx (fror neuropathy) and have not felt too good. I have experienced headaches and nausea.

  48. Maryann
    Maryann August 3, 2007 at 1:53 am | | Reply

    I have been taking Januvia for about 3 months. I have begun to retain fluids big time during the last week and a half. This is what happened with Actos. Anyone else having fluid retention?

    GLENDA COSENZA August 6, 2007 at 2:16 pm | | Reply

    I’ve been taking Januvia (replacing Actos) since February. No side effects that I can notice that I would attribute to the drug. Except my BS is now 150 — highest it’s ever been — so I’m probably going to return to the Actos which was a MIRACLE drug for me — except that my dr. and I thought it had resulted in about 15 lbs. of weight gain. Pick your poison.

  50. Paula Moore
    Paula Moore August 9, 2007 at 9:10 am | | Reply

    I took my first dose of Januvia and felt light headed, pressure behind eyes, weak, nauseated. I told doc I would try one half at night time. My bs reading has been 120 for about a yr, and doc decided I needed to try this medication. It worked ok at nighttime, with the lowered dose. Am new to all this, not even having knowing how to test my bs. Will attend a class, and get info, etc. Meanwhile, is it the usual for a person for 120 bs to go on Januvia or any other bs lowering meds?

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