Dr. Ahmed Tradjenta Vs Januvia is a comparison of the two most commonly prescribed DPP-IV inhibitors: Linagliptin and Sitagliptin.
Tradjenta and Januvia are prescription medications used to treat type 2 diabetes in adults. They belong to a group of drugs called DPP-4 inhibitors, which help lower blood sugar levels by regulating the amount of insulin needed.
Tradjenta got FDA approval for Diabetes in 2011 while Januvia was approved in 2006. There has been a vast experience with Januvia, however, Tradjenta is being increasingly used because of its safety in diabetic patients with kidney disease.
Tradjenta Vs Januvia: Pharmacokinetic differences:
Tradjenta and Januvia both belong to the same class of medicines, however, there are certain differences that are the reasons to choose one over the other.
Linagliptin (Tradjenta) | Sitagliptin (Januvia) | |
| Metabolism | None | None |
| Excretion | Biliary (<6% via kidneys) | Renal |
| Half-life | 10 – 40 hours | 8 – 24 hours |
| DPP-IV inhibition | 80% Max | 97% Max |
Januvia is a strong inhibitor of the enzyme, DPP-IV and is therefore likely to lower the A1C more. However, whether it really lowers the A1C greater than Linagliptin is discussed below.
In addition, because of the biliary route of excretion, Tradjenta (Linagliptin) is preferred in patients with renal dysfunction [Ref]
What is Tradjenta:Tradjenta is the brand name of “Linagliptin” which is a medicine used to treat Diabetes Type 2. It can be used to treat Diabetes as monotherapy or in combination with other medicines like metformin, Sulfonylurea, and SGLT2 inhibitors (Jardiance, Farxiga, or Invokana). Concomitant use with GLP-1 analogs (Ozempic, Rybelsus, and Victoza) is not recommended. Tradjenta acts by inhibiting the enzyme DPP-IV. Thus, it increases the half-life of endogenous incretins. Incretins cause the release of insulin in a glucose-dependent mechanism, improving satiety, delaying gastric emptying, and enhancing insulin sensitivity. |
Side effects of Tradjenta (Linagliptin):
Tradjenta, like all other DPP-IV inhibitors, causes GI upset. Most people develop constipation, fullness, flatulence, abdominal pain, nausea, and abdominal cramps.
Diarrhea may occur in some patients. Patients may also notice flu-like symptoms, runny nose, and irritation in the throat.
Hypoglycemia is not common with Tradjenta but can occur if it is used with insulin or other antidiabetic medications.
One of the most serious complications of Tradjenta and other DPP-IV inhibitors is pancreatitis. Pancreatitis is a serious side effect of all DPP-IV inhibitors and incretins.
Patients usually develop a dull aching pain in the epigastrium that radiates to the back associated with nausea and vomiting.
Precautions when using Tradjenta:
- If you have any allergic reaction, make sure to tell your doctor or pharmacist the details.
- It is important to tell your doctor what medicines you are already taking including those that are without a prescription. It will help your doctor not to prescribe medicines that reduce the effect when taken in combination with Tradjenta. Importantly, drugs used to treat Tuberculosis can reduce the efficacy of Tradjenta.
- If you are pregnant or planning to conceive, inform your doctor.
- Inform your doctor if you have had pancreatitis or gallstones.
What is Januvia:Januvia is a medication used to manage diabetes type 2. It belongs to a class called dipeptidyl peptidase-4 inhibitors or Dpp-4 inhibitors. Januvia works by indirectly improving insulin secretion. This works by preventing a group of hormones called incretins from being destroyed. Incretins are naturally occurring substances in the body that are released in response to food. These cause an increase in insulin secretion. The DPP-4 enzymes are responsible for breaking down incretins. So Januvia inhibits the DPP-IV enzymes from destroying incretins. The result is that there are more circulating incretins leading to sustains amount of insulin and better glucose levels. |
Side effects of Januvia :
Some of the reported side effects of Januvia include headache, diarrhea, and upset stomach. Gastrointestinal side effects are among the most commonly reported side effects.
Constipation, fullness, bloating, abdominal gases, nausea, and diarrhea may develop in patients using Januvia.
Hypoglycaemia is also a very common symptom. However, it occurs usually in patients taking other antidiabetic drugs like insulin. In addition to these, sore throat and runny nose are also noticed.
Precautions when taking Januvia:
The following are the precautions you must take care of when using Januvia:
- Make sure to report any rash that develops after taking Januvia as it is rarely associated with a condition called Steven-Johnson Syndrome. It’s a serious medical condition so it requires serious attention if it happens.
- Let your doctor know if you have a record of kidney disease. You can still take Januvia with kidney disease but at the lowest possible dose.
- In rare cases, Januvia has been correlated to angioedema which is an allergic reaction that may be characterized by swelling of the tongue, face, and lips. Be sure to let your doctor know if you have such a history.
- Report to your doctor if you have any joint or muscle pain.
- Tell your doctor if you have had pancreatitis or gallstones.
The usual dosage of Tradjenta and Januvia:
Tradjenta [Ref] and Januvia [Ref] are taken orally. They may be taken once daily after a meal, usually after dinner. To reduce the gastrointestinal side effects associated with these drugs, you can take them between meals as well.
Tradjenta | Januvia | |
| Generic name | Linagliptin | Sitagliptin |
| Daily dosage range | 5 mg | 100 mg |
| Recommended frequency | Once daily.No adjustment is needed in patients with kidney impairment | Once daily.Dose adjustment is needed in patients with kidney impairment. |
Both these drugs are also available in combination with other antidiabetic medicines:
Tradjenta combination pills:
- Jentadueto XR: Linagliptin and metformin
- Glyxambi: Linagliptin + Empagliflozin (Jardiance)
- TriJardy-XR: Jardiance + Linagliptin + metformin
Januvia combination pills:
- Janumet: contains Januvia (Sitagliptin) and metformin
Which drug is more effective in lowering A1C: Tradjenta Vs Januvia:
Both drugs belong to the same class of medicines. They have not been tried in a head-to-head comparison. In a network meta-analysis, Tradjenta and Januvia were compared.
Both Tradjenta and Januvia resulted in a greater A1C reduction compared to the placebo. Although Januvia was seen to lower the A1C by 0.2% greater than Tradjenta, the results were not statistically significant [Ref].
Tradjenta | Januvia | |
| A1C lowering effects | 0.4% | 0.6% |
| Glucose lowering effects | Reduce both fasting and postprandial level | Reduce both fasting and postprandial level |
| Beta cell function | Improves Beta-Cell functions to a lesser degree compared to Januvia | Improves Beta-cell function |
In a Chinese study that included a total of 535 patients, patients who could not achieve optimal glycemic control despite metformin and insulin were given one of the three gliptins for 12 weeks [Ref]:
- Sitagliptin (Januvia) @ 100 mg per day
- Vildagliptin (Galvus) @ 50 mg twice daily, and
- Linagliptin (Tradjenta) @ 5 mg once daily
The A1C-lowering effects of the three drugs are mentioned in the table below:
| Linagliptin | Sitagliptin | Vildagliptin | |
| A1C at baseline | 9.58% | 9.22% | 9.59% |
| A1C after 12 weeks | 8.56% | 8.26% | 8.16% |
| A1C reduction | -0.81% | -0.84% | -1.33% |
Galvus (Vildagliptin) was superior in lowering A1C compared to Linagliptin and Sitagliptin. The A1C-lowering effects of Tradjenta (Linagliptin) and Januvia (Sitagliptin) were comparable.
Which drug is more effective in reducing weight: Tradjenta Vs Januvia:
In a network meta-analysis that indirectly compared the weight loss effects of Linagliptin (Tradjenta) and Sitagliptin (Januvia), it was observed that compared to placebo and Januvia, Linagliptin users had significant weight loss [Ref].
Januvia use was not associated with any changes in weight compared to the placebo, however, it was inferior to Tradjenta (Linagliptin) in terms of weight loss.
Other studies have reported variable results but most agree that the effect of Tradjenta vs Januvia on body weight is similar.
Similarities between Tradjenta and Januvia:
The followings are the common things in both medicines
- Both are oral medicines for diabetes mellitus type 2 and help lower blood glucose levels.
- Both are taken in addition to diet, exercise, and other anti-diabetics.
- Both have been proven to be safe in patients with cardiovascular diseases.
- Both work by the same mechanism of action which is by inhibiting dipeptidyl peptidase-4 enzymes that destroy incretins.
- Hypoglycemia is rarely seen in both.
Additional benefits of Tradjenta Vs Januvia:
Apart from the A1C-lowering effects and effect of Tradjenta and Januvia on body weight, these drugs also exert some additional benefits. These include:
Januvia | Tradjenta | |
| Blood pressure | Positive | Neutral |
| Renoprotective effect | Positive | Positive |
| Cardiovascular safety | Proven | Proven [Ref] |
| Weight gain | Neutral | Neutral to slightly weight-losing effect |
| Hypoglycaemia | Neutral | Neutral |
| Retinopathy | Beneficial effect but detrimental in proliferative retinopathy | Beneficial effect |
| Wound healing | NA | NA |
Conclusion:
Tradjenta and Januvia are potent medicines approved for the treatment of Diabetes Type 2. They are not indicated for the treatment of patients with Type 1 Diabetes mellitus.
Both these drugs are considered euglycemic (do not cause hypoglycemia unless combined with other diabetes medicines). These drugs have been proven safe in patients with renal and cardiac diseases.
If we talk about their storage, these should be stored away from the heat at room temperature. Moisture and light should also be avoided.
Both medications should be taken at the doctor’s advice. You should make sure not to take smaller or larger doses as compared to what your doctor recommended to you.
