Can Victoza and Januvia be used together?
- Victoza (generic name: liraglutide), a GLP-1 agonist, plus Januvia (generic name: sitagliptin), a DPP-4 inhibitor are not considered a recommended combination for treatment of type 2 diabetes based on the American Diabetes Association - Standards of Medical Care 2020 guidelines.
- In general, studies have not shown a benefit of using a GLP-1 agonist in combination with a DPP-4 inhibitor. The combined use of a GLP-1 agonist with a DPP-4 inhibitor, both incretin-based drugs, have not been shown to significantly lower blood sugar when combined as treatment or have additive effects on weight loss.
- Added cost may be a significant factor, as well, as these treatments are expensive without an added benefit.
Victoza OR Januvia may be considered a recommended second-line agent to add to initial metformin therapy for certain patients, based on specific therapeutics needs.
Victoza is recommended as a second-line agent over Januvia in patients with established heart disease or chronic kidney disease. Victoza is approved to help reduce the risk of serious heart problems such as heart attack or stroke in adults with type 2 diabetes and heart disease.
The selection of a GLP-1 agonist (like Victoza) OR a DPP-4 inhibitor (like Januvia) as a second-line agent may be appropriate in patients without established cardiovascular risk factors but in need of an agent that won’t significantly lower blood sugar (cause hypoglycemia).
If a third-line agent was needed to further lower blood sugar in patients using metformin plus Victoza, a sodium-glucose cotransporter-2 inhibitor (SGLT2i) or thiazolidinedione (TZD) agent would typically be selected.
The choice of a second- or third-line medication should be based on patient-specific considerations and medication factors such as effectiveness, risk of causing low blood sugar, other medical conditions, weight concerns, drug side effects, and cost.
What are Victoza and Januvia?
Victoza is an injectable medicine, while Januvia is an oral tablet. Both drugs are used once a day, in addition to diet and exercise, to help control blood sugar levels in patients with type 2 diabetes.
Victoza is used in addition to diet and exercise to lower blood sugar (glucose) in adults and children who are 10 years of age and older with type 2 diabetes mellitus. Victoza is also used to reduce the risk of major cardiovascular events such as heart attack, stroke or death in adults with type 2 diabetes mellitus with known heart disease.
- Victoza is classified as a glucagon-like peptide-1 (GLP-1) receptor agonist, also called an incretin mimetic.
- It works to control blood sugar by increasing insulin release in response to a meal and slows down digestion of food in your stomach.
Januvia is used in addition to diet and exercise to improve blood glucose (blood sugar) control in adults living with type 2 diabetes.
- Januvia is an oral tablet that is taken once a day, with or without food.
- Januvia is classified as a dipeptidyl peptidase-4 (DPP-4) inhibitor.
- It lowers blood sugar levels by increasing the release of insulin from your pancreas in response to a meal.
Are there drug interactions between Victoza and Januvia?
Both Victoza (liraglutide) and Januvia (sitagliptin) belong to the 'incretin-based therapies' category. In this case, there is a therapeutic duplication. The recommended maximum number of medicines in the 'incretin-based therapies' category to be taken at the same time is usually one.
Always tell your doctor and pharmacist about all the medications you take, including prescription medicines, over-the-counter treatments, vitamins, herbals and other dietary supplements.
- Victoza and Januvia are both incretin-based therapies used in type 2 diabetes and are not usually combined due to a lack of increased effect in lowering blood sugar and no added effect on weight loss.
- In addition, combining these two groups of drugs may drastically increase your cost of therapy without much added benefit.
- Standard type 2 diabetes treatment guidelines, such as the American Diabetes Association - Standards of Medical Care 2020 do not recommend the combined use of a GLP-1 agonist (like Victoza) with a DPP-4 inhibitor (such as Januvia).
This is not all the information you need to know about Victoza and Januvia for safe and effective use. Review the full Victoza and Januvia product label, and discuss this information with your doctor or other health care provider
- Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care 43.Supplement 1 (2020): S98-S110. Accessed 24 June. 2020 at https://care.diabetesjournals.org/content/43/Supplement_1
- Lajthia E, Bucheit JD, Nadpara PA, Dixon DL, Caldas LM, Murchie M, Sisson EM. Combination therapy with once-weekly glucagon like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes: a case series. Pharm Pract 2019. Dec.12;17(4):1588. Accessed June 23, 2020 at https://doi.org/10.18549/PharmPract.2019.4.1588
- Wexler D, et al. Management of persistent hyperglycemia in type 2 diabetes mellitus. Up to Date. Accessed June 23, 2020 at https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus
- Grenell J. Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists. Clinical Advisor. Feb 17, 2017. Accessed June 24, 2020 at https://www.clinicaladvisor.com/home/features/clinical-challenge/case-study-in-diabetes-use-of-dpp-4-inhibitors-with-glp-1-agonists/2/
- Foster M. Adding Sitagliptin to Liraglutide Provided No Extra Benefit in Diabetes. Endocrinology Advisor. June 7, 2015. Accessed June 24, 2020 at https://www.endocrinologyadvisor.com/home/conference-highlights/ada-75th-scientific-sessions-2015/adding-sitagliptin-to-liraglutide-provided-no-extra-benefit-in-diabetes/
- George C, et al. Drug Combo Adds No Benefit in Patients with Type 2 Diabetes. Letter to the Editor. Am Fam Physician. 2016 Mar 15;93(6):436-438. Accessed June 23, 2020 at https://www.aafp.org/afp/2016/0315/p436.html#afp20160315p436-b2
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