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Januvia vs Invokana
Introduction
For patients with type 2 diabetes, certain drugs that affect the regulation of blood sugar levels can help in controlling hyperglycemia and managing symptoms. Januvia and Invokana are two such medications prescribed for this condition. They each impact different processes in the body related to glucose control but both work towards maintaining optimal blood sugar levels in patients with diabetes. Januvia is a dipeptidyl peptidase-4 (DPP-4) inhibitor which works by increasing the level of incretin hormones, thereby regulating insulin release after meals and reducing the amount of glucose produced by the liver. Invokana, on the other hand, is classified as a sodium-glucose co-transporter 2 (SGLT2) inhibitor which helps lower blood sugar by causing kidneys to remove sugar from your body through urine.
Januvia vs Invokana Side By Side
| Attribute | Januvia | Invokana |
|---|---|---|
| Brand Name | Januvia | Invokana |
| Contraindications | Should not be taken if using drugs that affect kidney function like NSAIDs, diuretics, or ACE inhibitors. Risk of pancreatitis. | Should not be taken if using drugs that affect kidney function like NSAIDs, diuretics, or ACE inhibitors. Higher risk for genital fungal infections. |
| Cost | Around $500 for 30 tablets of 100 mg | Around $600 for 30 tablets of 300 mg |
| Generic Name | Sitagliptin | Canagliflozin |
| Most Serious Side Effect | Pancreatitis | Ketoacidosis, risk of amputation |
| Severe Drug Interactions | NSAIDs, diuretics, ACE inhibitors | NSAIDs, diuretics, ACE inhibitors |
| Typical Dose | 25–100 mg/day, commonly 100 mg once daily | 100 mg once daily, can increase to 300 mg/day |
What is Januvia?
Sitagliptin (the generic name for Januvia) was one of the first drugs in the DPP-4 inhibitor class of anti-diabetic medications, marking a major advancement from prior classes like sulfonylureas and biguanides. Sitagliptin was first approved by the FDA in 2006. Januvia assists in managing blood sugar levels by inhibiting the enzyme DPP-4, which results in an increased production of insulin and decreased release of glucagon, thereby lowering glucose production by the liver. It is commonly used for treating type 2 diabetes.
On another note, Canagliflozin (the generic name for Invokana) belongs to a newer class called SGLT2 inhibitors that work differently than DPP-4 inhibitors. Approved by FDA in 2013, its mechanism involves blocking the reabsorption of glucose by kidneys thus leading to more glucose being excreted through urine.
While both these medications aim at controlling high blood sugar levels associated with type 2 diabetes; they possess different mechanisms and potential side effects profiles.
What conditions is Januvia approved to treat?
Januvia and Invokana are both approved for the treatment of type 2 diabetes:
- Januvia (sitagliptin) is a DPP-4 inhibitor that works by increasing hormones in the body that can lower raised blood sugar levels.
- Invokana (canagliflozin), on the other hand, is an SGLT2 inhibitor which helps to reduce high blood sugar by causing the kidneys to get rid of more glucose in the urine.
How does Januvia help with these illnesses?
Januvia aids in the management of type 2 diabetes by increasing levels of incretins, hormones that stimulate a decrease in blood sugar levels. It achieves this by inhibiting DPP-4 (dipeptidyl peptidase-4), an enzyme that breaks down incretin hormones; hence, allowing these hormones to remain active for longer periods. Incretin hormones play crucial roles in glucose metabolism and insulin secretion. Individuals with type 2 diabetes often have lower than normal amounts of these vital hormones. Consequently, by boosting their levels through blocking DPP-4, Januvia can mitigate the adverse effects associated with high blood sugar and help patients regulate their condition more effectively.
On the other hand, Invokana works differently as it lowers blood glucose levels by causing kidneys to remove excess sugar from your body through urine. This mechanism is particularly useful for those who struggle with insulin resistance or inadequate insulin production.
What is Invokana?
Invokana is a brand name for canagliflozin, which is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. It works by blocking the reabsorption of glucose in the kidney, increasing glucose excretion, and lowering blood sugar levels in diabetes patients. Invokana was first approved by the FDA in 2013. As canagliflozin isn't an DPP-4 inhibitor like Januvia (sitagliptin), it doesn't work by boosting the levels of insulin after meals while decreasing the amount of glucose that your liver makes. Its unique action means its side-effect profile is also different from that of DPP-4 inhibitors such as Januvia; notably it may lead to urinary tract infections and genital fungal infections due to increased sugar in urine but less likely to cause weight gain or hypoglycemia (common side effects with some other diabetic medications). The effects on reducing blood sugar via kidneys could be beneficial for treatment of type 2 diabetes mellitus especially when patients do not respond well or are intolerant to "typical" DPP-4 inhibitors like Januvia.
What conditions is Invokana approved to treat?
Invokana is an FDA-approved medication utilized in the management of:
- Type 2 diabetes, as a means to improve glycemic control
- Heart disease risk reduction in patients with type 2 diabetes and established cardiovascular disease or at high risk for cardiovascular events.
This drug works by inhibiting sodium-glucose co-transporter 2 (SGLT2) which leads to increased excretion of glucose in urine, thus lowering blood sugar levels.
How does Invokana help with these illnesses?
Invokana is a SGLT2 inhibitor that plays a critical role in managing type 2 diabetes by blocking the reabsorption of glucose in the kidneys, thereby promoting its excretion through urine and lowering blood sugar levels. This innovative mechanism of action is different from other anti-diabetic medications such as Januvia. Instead of increasing insulin production or decreasing the amount of glucose produced by the liver like Januvia, Invokana directly targets glucose elimination. Moreover, it may also contribute to weight loss and lower blood pressure — additional benefits for individuals with diabetes who often struggle with these health concerns. As with any medication, response can vary between patients so it's important to carefully monitor glycemic control when initiating treatment or changing medication regimens.
How effective are both Januvia and Invokana?
Both sitagliptin (Januvia) and canagliflozin (Invokana) have established histories of success in treating patients with type 2 diabetes, with their FDA approvals being only a few years apart. They both act on different aspects of glucose metabolism and may be prescribed under different circumstances. The effectiveness of sitagliptin and canagliflozin in managing blood sugar levels was directly studied in a double-blind clinical trial in 2013; the two drugs exhibited similar efficacy in reducing HbA1c levels, an important measure of long-term blood glucose control.
Sitagliptin works by inhibiting DPP-4, an enzyme that deactivates incretin hormones. This results in increased insulin production when blood sugar is high, as well as decreased glucagon release which lowers hepatic glucose production. A review from 2007 reported that it effectively reduces HbA1c levels starting from the first week of treatment without causing hypoglycaemia or weight gain - common issues associated with other antidiabetic medications.
Canagliflozin operates via a completely different mechanism - it inhibits SGLT2 proteins responsible for reabsorbing glucose back into circulation from the kidneys. Thus more glucose gets excreted through urine lowering overall blood sugar level. A 2014 meta-analysis indicated that canagliflozin not only reduces HbA1c but also causes modest weight loss and reduction in systolic blood pressure due to its diuretic effect - something unique to SGLT2 inhibitors like Invokana.
While both Januvia and Invokana are effective at managing type 2 diabetes symptoms, they each have their own side effects profile; Januvia has been linked to acute pancreatitis while Invokana carries risks related to urinary tract infections due to its mode of action.
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At what dose is Januvia typically prescribed?
Oral dosages of Januvia range from 25–100 mg/day, with the common dosage being 100 mg once daily. It can be taken regardless of meals. On the other hand, Invokana is typically started at a dose of 100 mg once daily, taken before the first meal of the day. If necessary and well-tolerated, this dosage may increase to 300 mg/day for better blood sugar control. In either medication choice, it's important to monitor your glucose levels regularly and discuss any changes or concerns with your healthcare provider.
At what dose is Invokana typically prescribed?
Invokana treatment for Type 2 diabetes is typically initiated at a dosage of 100 mg, taken orally once daily before the first meal of the day. If necessary and well-tolerated, this dose can be increased to 300 mg per day. For kidney disease risk reduction in patients with Type 2 diabetes mellitus and diabetic nephropathy with albuminuria, Invokana should be started at 100 mg once daily and can be increased to a maximum of 300mg/day if eGFR remains persistently above >60 mL/min/1.73 m². It's crucial that your healthcare provider monitors your response to treatment regularly as certain factors such as renal function may affect dosing considerations.
What are the most common side effects for Januvia?
Common side effects of Januvia and Invokana include:
- Upper respiratory infection
- Urinary tract infection, increased urination
- Yeast infections (in women)
- Thirst
- Constipation, nausea
- Hypoglycemia (low blood sugar)
- Headache, dizziness
- Stomach pain or discomfort
- Weakness and fatigue These medications also carry a risk of serious side effects including pancreatitis and ketoacidosis. If you experience any severe symptoms such as difficulty breathing or swallowing, swelling in your face or throat, severe stomach pain that won't go away or unusual bruising/bleeding - seek medical attention immediately.
Are there any potential serious side effects for Januvia?
While Januvia and Invokana are both prescribed for the treatment of type 2 diabetes, they each have their own unique side effects. For Januvia, rare but serious potential side effects include:
- Pancreatitis which could cause severe stomach pain that will not go away and may move to your back, with or without vomiting.
- An allergic reaction which includes symptoms such as rash; raised red patches on your skin (hives); swelling of the face, lips, tongue and throat that may cause difficulty in breathing or swallowing.
For Invokana, possible serious side effects include:
- Dehydration leading to low blood pressure (hypotension) which can make you feel dizzy or faint; particularly if you take any blood pressure medications.
- Ketoacidosis: a serious condition where the body produces high levels of ketones. Symptoms can include nausea, tiredness, stomach pain and trouble breathing.
- Serious urinary tract infection: You should look out for symptoms like burning sensation while urinating, pelvic pain or passing frequent small amounts urine.
Both drugs also carry a risk of hypoglycemia when used with other medications designed to lower blood sugar. If you experience any unusual symptoms while taking these drugs it is important to contact your healthcare provider immediately.
What are the most common side effects for Invokana?
Invokana, when compared to Januvia, has a different profile of potential side effects. These may include:
- Increased urination
- Thirst and dry mouth due to dehydration risk
- Yeast infection in women and men
- Nausea or vomiting
- Abdominal pain
- Fatigue or weakness
- Constipation or other changes in bowel habits
- Weight loss as the body starts excreting more glucose through urine
- Rash or skin sensitivity to sunlight
- Low blood sugar (hypoglycemia) if used with certain other diabetes drugs.
It is noteworthy that Invokana can also lead to serious issues such as kidney problems, low blood pressure (which can cause dizziness and fainting), high potassium levels in your blood (hyperkalemia), leg and foot amputations, fractures/bone density loss, abnormal cholesterol levels. It's crucial that these factors are considered while making an informed decision about which medication suits you best. As always consult your healthcare provider for personalized advice.
Are there any potential serious side effects for Invokana?
While Invokana is generally safe and effective for the treatment of type 2 diabetes, it's critical to be aware of potential adverse effects. Some serious side effects might include:
- Allergic reactions such as skin rash, itching or hives, swelling of the face, lips or tongue
- Breathing problems
- Signs of dehydration: dry mouth, increased thirst, irregular heartbeat, confusion or weakness
- Symptoms related to a urinary tract infection: pain when urinating; changes in urine color; odor; cloudy appearance
- Unusual weight loss
- Signs of high potassium level: muscle weakness, slow heart rate.
Should you encounter any such symptoms while taking Invokana consult your healthcare provider without delay. Additionally remember that maintaining regular doctor appointments and conducting routine lab tests are beneficial in promptly identifying and addressing any potential issues.
Contraindications for Januvia and Invokana?
Both Januvia and Invokana, along with most other diabetes medications, may cause hypoglycemia (low blood sugar) in some people. If you experience symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger blurred vision or dizziness please seek immediate medical attention.
Neither Januvia nor Invokana should be taken if you are taking drugs that can affect kidney function like NSAIDs (like ibuprofen), diuretics or ACE inhibitors. Always tell your physician which medications you are taking; these will require careful monitoring to prevent harmful interactions with Januvia and Invokana.
Januvia is less likely than Invokana to cause urinary tract infections but more likely to cause joint pain and inflammation of the pancreas (pancreatitis). On the other hand, Invokana has a higher risk for genital fungal infections because it works by excreting excess glucose through urine.
It's also important to note that both drugs can potentially lead to ketoacidosis - a serious condition where body starts burning fat too quickly causing acid build up in bloodstream. This condition can sometimes occur even when blood sugars are normal. Therefore regular testing for ketones especially during periods of illness is recommended.
Always make sure your doctor knows all about your medical history before prescribing either medication.
How much do Januvia and Invokana cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Januvia (100 mg) averages around $500, which works out to approximately $16.70/day.
- The price for 30 tablets of Invokana (300 mg), on average, is about $600, working out to around $20/day.
Thus, if cost is a significant factor for you, Januvia may be the more affordable option per-day basis compared to Invokana. However, it's crucial that cost not be your primary consideration when deciding between these two diabetes medications; effectiveness and side effect profile are equally important factors.
As for generic versions: currently there are no FDA-approved generics available in the U.S. for either Januvia or Invokana. Therefore, costs remain high with both medications.
Popularity of Januvia and Invokana
Sitagliptin, also known by the brand name Januvia, was prescribed to about 9.3 million patients in the United States in 2020. It is a type of drug called a DPP-4 inhibitor and is used for managing type 2 diabetes. This medication helps regulate blood sugar levels by increasing hormones that stimulate your pancreas to produce more insulin and your liver to produce less glucose.
Canagliflozin, sold under the brand name Invokana, had approximately 1.6 million prescriptions filled in the US during the same year. As an SGLT2 inhibitor, it works differently than sitagliptin; it causes kidneys to excrete more glucose from your body through urine which lowers blood sugar levels in adults with type 2 diabetes.
While both medications are effective at controlling high blood sugar levels associated with type 2 diabetes, they do so via different mechanisms and may be chosen based on individual patient factors such as other health conditions or potential side effects.
Conclusion
Both Januvia (sitagliptin) and Invokana (canagliflozin) have well-established usage in patients with type 2 diabetes, supported by numerous clinical studies indicating their effectiveness in reducing blood sugar levels. Sometimes these drugs may be used together to enhance glycemic control but this decision would require careful evaluation by a healthcare professional as they can affect the body differently. Januvia works primarily by increasing insulin production while decreasing the amount of glucose produced by the liver; on the other hand, Invokana reduces blood sugar level mainly through promoting excretion of glucose via urine.
Januvia and Invokana are both available in generic forms which offers significant cost savings especially for those who are paying out-of-pocket. The onset of action varies between each medication, meaning that it may take time for some patients to notice improvements in their blood glucose control after starting treatment.
The side effect profile is somewhat similar between Januvia and Invokana – they’re generally well-tolerated but come with different risks: Januvia has been associated with pancreatitis whereas Invokana carries higher risk for genital yeast infections and urinary tract infections due to its mechanism of action. In people at high risk for heart disease or stroke, cardiovascular benefits might influence drug choice – both medications have shown cardiovascular benefits but results were more pronounced with SGLT2 inhibitors like Invokana. As always, close monitoring of blood sugars along with regular follow-up appointments are essential when initiating any new diabetic therapy.
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Refrences
- Schernthaner, G., Gross, J. L., Rosenstock, J., Guarisco, M., Fu, M., Yee, J., … Meininger, G. (2013, August 13). Canagliflozin Compared With Sitagliptin for Patients With Type 2 Diabetes Who Do Not Have Adequate Glycemic Control With Metformin Plus Sulfonylurea. Diabetes Care. American Diabetes Association.http://doi.org/10.2337/dc12-2491
- Bardsley, J. K., & Ratner, R. E. (2008, November). Sitagliptin: an oral agent for glucose control. Expert Review of Endocrinology & Metabolism. Informa UK Limited.http://doi.org/10.1586/17446651.3.6.691
- Akhtar, N. (2013, November). Type 2 Diabetes Mellitus and Invokana: An FDA Approved Drug. Current Diabetes Reviews. Bentham Science Publishers Ltd.http://doi.org/10.2174/15733998113096660085
- Gelaye, A., Haidar, A., Kassab, C., Kazmi, S., & Sinha, P. (2016). Severe Ketoacidosis Associated with Canagliflozin (Invokana): A Safety Concern. Case Reports in Critical Care. Hindawi Limited.http://doi.org/10.1155/2016/1656182
- Gadsby, R. (2007, December). New treatments for type 2 diabetes—The DPP4 inhibitors. Primary Care Diabetes. Elsevier BV.http://doi.org/10.1016/j.pcd.2007.10.004
- Cheungpasitporn, W., Srivali, N., Thongprayoon, C., & Ungprasert, P. (2015). Acute pancreatitis in the use of canagliflozin: A rare side-effect of the novel therapy for type 2 diabetes mellitus. Journal of Basic and Clinical Pharmacy. Medknow.http://doi.org/10.4103/0976-0105.160753