Januvia vs Onglyza

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For patients with type 2 diabetes, certain drugs that alter the concentrations of compounds in the body, called incretins, can help in managing blood sugar levels. Januvia and Onglyza are two such drugs that are prescribed for this condition. They each impact different aspects of glucose metabolism but both have an effect on stabilizing glycemic control in patients with diabetes. Januvia (sitagliptin) and Onglyza (saxagliptin) belong to a class of medications known as dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors). These medicines work by increasing the amount of insulin produced by your body and decreasing the amount of glucose made by your liver. The choice between these two will depend on individual patient factors such as cost considerations, presence of kidney disease among others.

What is Januvia?

Sitagliptin (the generic name for Januvia) was a groundbreaking addition to the DPP-4 inhibitor class of antidiabetic medications, which represented a significant advance over first-generation oral hypoglycemic agents. Sitagliptin was first approved by the FDA in 2006. Januvia works by increasing levels of naturally produced incretins – hormones that help lower blood sugar levels – by preventing them from being broken down, effectively keeping them active in the body for longer than usual. It is prescribed for the treatment of type 2 diabetes mellitus along with diet and exercise modifications. Januvia selectively inhibits DPP-4 enzyme activity with minor influence on other enzymes, resulting in it having fewer side effects than other antidiabetics that have broader enzymatic effects.

Saxagliptin (the generic name for Onglyza) is another medication within the same class as Januvia and functions similarly to control high blood sugar levels in people with type 2 diabetes. However, there are differences between these two drugs regarding dosing frequency and potential side-effects which should be discussed with healthcare professionals before starting any medication regimen.

What conditions is Januvia approved to treat?

Januvia and Onglyza are both approved for the treatment of Type 2 Diabetes Mellitus. They work by increasing the levels of incretins to help control blood sugar by increasing insulin release, especially after a meal.

  • Januvia (sitagliptin) is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
  • Onglyza (saxagliptin) is also used alongside diet and exercise improvement programs to manage high blood sugar in patients with type 2 diabetes.

How does Januvia help with these illnesses?

Januvia aids in the management of type 2 diabetes by increasing the level of incretins available in the body. It does this by inhibiting their breakdown, thereby allowing them to remain active for longer periods. Incretins are hormones that stimulate insulin production and slow down gastric emptying after meals, leading to a decrease in blood glucose levels. They also inhibit glucagon release which further helps lower blood sugar levels.

Individuals with type 2 diabetes often have a relatively lower response to incretin hormones, hence making their bodies less effective at controlling high blood sugar levels after meals. Therefore, by elevating incretins' activity through Januvia's action, it can limit the negative effects of high post-meal glucose spikes and help patients manage their condition effectively.

What is Onglyza?

Onglyza is a brand name for saxagliptin, a drug used to regulate blood sugar levels in adults with type 2 diabetes. It functions as a DPP-4 inhibitor, meaning it inhibits the activity of the enzyme dipeptidyl peptidase-4, which degrades certain hormones that stimulate insulin secretion in response to increased blood glucose. Saxagliptin was first approved by the FDA in 2009. As saxagliptin does not work through insulin release stimulation or reduction of glucose production like other anti-diabetic drugs, its side-effect profile differs notably from those medications; it doesn't typically cause weight gain and has a low risk of hypoglycemia (common side effects associated with many oral anti-diabetic drugs). The specific action on DPP-4 can be beneficial for controlling blood sugar levels in patients who do not respond well to other types of anti-diabetic medication such as Januvia.

What conditions is Onglyza approved to treat?

Onglyza is a medication that has been approved by the FDA for use in managing:

  • Type 2 diabetes mellitus as an adjunct to diet and exercise
  • It can also be used alongside other medications when necessary, to help control high blood sugar levels.

How does Onglyza help with these illnesses?

Onglyza works by regulating the levels of insulin your body produces after eating. It is a DPP-4 inhibitor, meaning it blocks the action of an enzyme called dipeptidyl peptidase IV which breaks down hormones that stimulate insulin secretion in response to a meal. By inhibiting this enzyme, Onglyza prolongs the action of these hormones and allows for more balanced blood glucose levels post-meal.

Just like Januvia, Onglyza does not work when the blood glucose is low. Its ability to increase insulin release makes it effective in reducing high blood sugar levels seen in type 2 diabetes but has minimal risk of causing hypoglycemia when used alone. However, compared to Januvia, some studies suggest that Onglyza may be slightly less effective at lowering HbA1c (a measure of long-term blood glucose control), but this difference is likely clinically insignificant for most patients.

How effective are both Januvia and Onglyza?

Both sitagliptin (Januvia) and saxagliptin (Onglyza) have established histories of success in managing type 2 diabetes, having been approved by the FDA only a few years apart. They both belong to a class of medications known as dipeptidyl peptidase-4 (DPP-4) inhibitors which work to increase insulin levels and decrease glucagon production in the pancreas, leading to lower blood glucose levels. The effectiveness of Januvia and Onglyza was directly studied in several clinical trials; these two drugs exhibited similar efficacy in managing symptoms of type 2 diabetes along with comparable safety profiles.

A meta-analysis study conducted on sitagliptin reported that it is effective at reducing A1C levels from baseline starting within weeks from the initiation of treatment; its side effect profile compares favorably against many other antidiabetic drugs, including less risk for hypoglycemia or weight gain. It also appears well-tolerated even among elderly populations.

On the other hand, a review indicated that saxagliptin seems equally effective as placebo plus metformin in treating patients with inadequate glycemic control. However, it is typically considered an add-on therapy when lifestyle modifications or metformin alone do not provide adequate glycemic control. Saxagliptin has shown good tolerability with most adverse reactions being mild to moderate including upper respiratory tract infection and urinary tract infection.

While both medications are generally safe options for most people with type 2 diabetes, individual patient characteristics should be taken into account when deciding between them – such as kidney function status since dosing adjustments may be necessary.

abstract image of a researcher studying a bottle of drug.

At what dose is Januvia typically prescribed?

Oral dosages of Januvia are typically 100 mg/day, but for patients with kidney disease, the dosage may be adjusted down to 25-50 mg/day based on kidney function. There is no need for dose adjustment in elderly patients unless they have impaired kidney function. On the other hand, Onglyza is usually taken at a dose of 5mg once daily. For patients with moderate or severe renal impairment or end-stage renal disease, a reduced dose of Onglyza — specifically, 2.5mg per day — should be used instead due to their diminished ability to remove the drug from their bodies through normal metabolic processes. Neither medication's dosage should be increased past its respective standard maximum (Januvia: 100mg; Onglyza: 5mg) without medical consultation.

At what dose is Onglyza typically prescribed?

Onglyza treatment for type 2 diabetes is typically initiated at a dosage of 2.5 mg/day, taken once daily with or without food. Depending on the patient's kidney function and overall response to the medication, the dose can be increased to a maximum of 5 mg/day. The recommendation is that patients should have their blood sugar levels monitored regularly while taking Onglyza and adjustments in dosage made accordingly under medical supervision if there is no significant improvement in glycemic control after a few weeks at the initial dose.

What are the most common side effects for Januvia?

Common side effects of Januvia can include:

  • Upper respiratory tract infection
  • Stuffy or runny nose
  • Sore throat
  • Headache
  • Nausea, diarrhea, and stomach pain

On the other hand, potential mild to moderate side effects of Onglyza could comprise:

  • Upper respiratory tract infection
  • Urinary tract infection
  • Headache
  • Sinusitis (inflammation in the sinus cavities)

Remember that it's essential to discuss any noticeable symptoms with your healthcare provider as they may indicate a need for dosage adjustment or an alternative treatment plan.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Januvia?

While both Januvia and Onglyza are generally well tolerated, they may cause some serious side effects in rare cases:

  • Signs of allergic reaction: rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; chest tightness or trouble breathing.
  • Any signs of pancreatitis: severe stomach pain that won't go away and reaches to your back with or without vomiting.
  • Symptoms of heart failure like shortness of breath at rest or with activity, swelling in the arms or legs, sudden weight gain.
  • Kidney problems as marked by change in amount of urine passed, blood in the urine, difficulty urinating.
  • Joint pain
  • Unusual skin changes (blistering/peeling).

In case you experience any such symptoms while using either drug it is important to get medical help right away. Always consult a healthcare provider for professional advice about these medications' risks and benefits.

What are the most common side effects for Onglyza?

Side effects of Onglyza can include:

  • Headache
  • Upper respiratory tract infection, stuffy or runny nose
  • Urinary tract infection
  • Nausea and upset stomach
  • A risk of low blood sugar (hypoglycemia) when used in combination with certain other diabetes drugs
  • Swelling in the hands or legs
  • Sore throat

It's important to note that while these side effects might be common, they are usually mild and manageable. However, if you experience severe symptoms such as difficulty breathing or swallowing, swelling of the face, lips, tongue or throat – it could indicate a more serious reaction and you should seek immediate medical attention.

Are there any potential serious side effects for Onglyza?

Although Onglyza is widely used for the management of type 2 diabetes, it's not without potential side effects. Some adverse reactions to be aware of include:

  • Signs of an allergic reaction: rash, itching or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body
  • Symptoms indicating heart failure such as unusual shortness of breath during daily activities and waking up from sleep with trouble breathing. Other signs might also include unusual fatigue or weakness and sudden weight gain.
  • Severe joint pain
  • Pancreatitis symptoms like severe stomach pain that may spread to your back along with nausea and vomiting.

In case you experience any state above while taking Onglyza, it's important to seek immediate medical attention.

Contraindications for Januvia and Onglyza?

Both Januvia and Onglyza, like most drugs for managing diabetes, can potentially cause certain side effects. If you notice severe symptoms such as persistent nausea or vomiting, stomach/abdominal pain, unusual tiredness, or trouble breathing, please seek immediate medical attention.

Neither Januvia nor Onglyza should be taken if you are on dialysis or have a history of pancreatitis (inflammation of the pancreas). Always inform your doctor about all the medications you are currently taking; this includes prescription medicines, over-the-counter drugs and any dietary supplements. Certain medications could interact with Januvia or Onglyza in ways that may increase your risk for hypoglycemia (low blood sugar) or other serious conditions. It's also important to note that both these medications are not recommended for patients with type 1 diabetes or diabetic ketoacidosis.

How much do Januvia and Onglyza cost?

For the brand name versions of these drugs:

  • The price of 30 tablets of Januvia (100 mg) averages around $470, which works out to approximately $15.6/day.
  • The price for 30 tablets of Onglyza (5 mg) is about $390, working out to approximately $13/day.

Thus, if you are using a standard dose for either drug, then brand-name Onglyza is less expensive on a per-day treatment basis. Keep in mind that cost should not be your primary consideration in determining which of these medications suits you best.

Currently there are no generic versions available for both Januvia and Onglyza. Therefore the costs remain relatively high compared to many other types of medication that have generic alternatives. Always consult with your doctor or pharmacist regarding any financial concerns related to your prescription medications. They can provide guidance and may know about certain discount programs or insurance coverage options that can help manage costs.

Popularity of Januvia and Onglyza

Sitagliptin, available as a generic and under the brand name Januvia, was prescribed to around 8.6 million people in the United States in 2020. Sitagliptin accounted for approximately 21% of prescriptions for oral diabetes medications (excluding metformin) within that time frame. Since its introduction in 2006, sitagliptin has gained popularity due to its efficacy and tolerability profile.

Saxagliptin, sold under the brand name Onglyza among others, was prescribed to about 1 million people in the USA during the same period. Saxagliptin accounts for just over 2% of non-insulin/non-metformin oral diabetes medication prescriptions across the country. The prevalence of saxaglitpin has remained relatively steady since it entered clinical use in 2009.


Both Januvia (sitagliptin) and Onglyza (saxagliptin) are commonly prescribed to patients with type 2 diabetes, and have been proven more effective than placebo treatments in numerous clinical studies. They may be used together with other anti-diabetic drugs such as metformin or insulin, but the combination should always be under a physician's guidance due to potential drug interactions. Both of these medications belong to the class of DPP-4 inhibitors which work by increasing levels of incretin hormones that help lower blood sugar.

Januvia is often considered a first-choice treatment option owing to its once-daily dosing regimen and minimal risk of hypoglycemia when used alone. On the other hand, Onglyza could be considered as an alternative for those who do not tolerate Januvia well or when cost becomes an issue since it's typically cheaper.

Both Januvia and Onglyza are available in generic forms providing significant cost savings especially for uninsured patients. The onset time varies among individuals so it might take some days before noticeable effects on blood glucose control can be seen after starting either medication.

The side effect profiles between the two drugs are generally similar; both being generally well-tolerated although there are reports of minor side effects such as upper respiratory tract infections, urinary tract infections, headaches, etc., along with more serious ones like pancreatitis and heart failure risk particularly in pre-existing cases. It's important that patients using either medication monitor their blood sugar regularly and report any unusual symptoms immediately to their doctor.