Sitagliptin: Uses, Dosage, Side Effects & Cost
Sitagliptin: Uses, Dosage, Side Effects & Cost (2026)
Last updated: 2026-01-30
Sitagliptin is a prescription medicine used to help improve blood sugar control.
In the U.S., it’s commonly sold under the brand name Januvia and is indicated (along with diet and exercise) for adults with type 2 diabetes (FDA Januvia prescribing information, updated 2024 (PDF)).
Sitagliptin is an oral DPP-4 (dipeptidyl peptidase-4) inhibitor. In simple terms, it helps lower blood sugar by boosting the body’s “incretin” hormone effect after meals (DrugBank: sitagliptin DB01261).
Country note: Brand names, available formulations, and prescribing details can vary by country. Unless otherwise stated, dosing details below reflect U.S. labeling.
Quick recap (high level):
- Usual adult dose with adequate kidney function is 100 mg once daily, but dosing is individualized and reduced with decreased kidney function (per the FDA label, updated 2024 (PDF)).
- It can be taken with or without food.
- Commonly listed side effects include headache and cold-like nose/throat symptoms (Mayo Clinic: sitagliptin (oral route)).
Important: This article is for education only—not medical advice. Don’t start, stop, or change any medication without guidance from your clinician.
What is sitagliptin?
Sitagliptin is an oral medication for type 2 diabetes.
It may be prescribed alone or with other diabetes medicines, depending on your needs and what you tolerate (Mayo Clinic: sitagliptin (oral route)).
It is not used for:
- Type 1 diabetes, or
- Diabetic ketoacidosis (DKA)
Brand names and combination products
Depending on the product your clinician prescribes, you may see sitagliptin by itself or in a combination pill.
MedlinePlus lists Januvia® and combination products like Janumet®/Janumet XR® (sitagliptin + metformin) and Steglujan® (sitagliptin + ertugliflozin) (MedlinePlus: sitagliptin drug information).
Who should not take sitagliptin? (Contraindications & key cautions)
Contraindication (the clear “do not”)
Don’t take sitagliptin if you’ve had a serious hypersensitivity reaction to it (for example, anaphylaxis or angioedema), as listed in the official U.S. labeling (DailyMed: Januvia (sitagliptin) label).
Situations to discuss with your clinician
These aren’t always automatic “no’s,” but they’re common reasons your clinician may adjust the plan:
- Kidney disease: dosing depends on kidney function.
- History of pancreatitis: sitagliptin hasn’t been studied in people with a history of pancreatitis, and pancreatitis has been reported postmarketing (described in the official U.S. label).
- Pregnancy or breastfeeding: discuss risks/benefits before starting or continuing.
How does sitagliptin work? (Mechanism of action)
Sitagliptin blocks DPP-4, an enzyme that breaks down incretin hormones such as GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide)—gut hormones that help signal insulin release after meals (DrugBank: sitagliptin DB01261).
A friendly analogy: incretins are like your gut’s “meal texts” to your pancreas. Sitagliptin helps those messages stay readable a bit longer.
Sitagliptin dosage (including kidney/renal dose adjustments)
Sitagliptin is taken once daily.
Standard adult dose
For many adults with adequate kidney function, the recommended dose is 100 mg once daily (see Dosage & Administration in the DailyMed: Januvia (sitagliptin) label).
Kidney (eGFR) dose adjustment table
eGFR means estimated glomerular filtration rate—a lab-based estimate of how well your kidneys are filtering.
| Kidney function (eGFR) | Typical sitagliptin dose |
|---|---|
| eGFR ≥ 45 mL/min/1.73 m² | 100 mg once daily |
| eGFR 30 to <45 mL/min/1.73 m² | 50 mg once daily |
| eGFR < 30 mL/min/1.73 m²(including end-stage kidney disease on dialysis) | 25 mg once daily |
Quick heads-up: This table is for sitagliptin-only products (like Januvia). If you take a combination medication (like Janumet or Steglujan), don’t assume the same table applies—combo products have their own dosing rules.
If you miss a dose
If you miss a dose, take it when you remember—unless it’s almost time for the next one. If it’s close, skip the missed dose and go back to your regular schedule. Don’t double up (MedlinePlus: sitagliptin drug information).
Side effects of sitagliptin
Side effects aren’t one-size-fits-all. Most people don’t get every side effect—but it helps to know what’s common vs. what’s “call for help.”
Common side effects
Mayo Clinic lists possible side effects such as a runny/stuffy nose and sore throat symptoms, and headache (Mayo Clinic: sitagliptin (oral route)).
Serious side effects (get urgent medical help)
Seek urgent care for symptoms that could signal something serious, such as:
- Pancreatitis: severe, persistent stomach pain that may spread to the back
- Severe allergic reaction / angioedema: swelling of the face/lips/tongue/throat, hives, trouble breathing
- Severe skin reactions: blistering or peeling skin
- Possible heart failure symptoms: shortness of breath, unusual tiredness, rapid weight gain, swelling of the feet/ankles
MedlinePlus lists these types of symptoms as reasons to seek immediate medical attention (MedlinePlus: sitagliptin drug information).
Severe joint pain (FDA safety warning)
The FDA warns that DPP-4 inhibitors (including sitagliptin) may cause severe and disabling joint pain (FDA Drug Safety Communication).
Bullous pemphigoid: what research suggests (rare, but worth knowing)
Observational research (which can show associations but can’t prove cause and effect) has linked DPP-4 inhibitors to bullous pemphigoid. For example, a large U.S. cohort study found a higher bullous pemphigoid risk among people who started a DPP-4 inhibitor compared with those who started a second-generation sulfonylurea (JAMA Dermatology cohort study (2020) via PMC).
Drug interactions & low blood sugar (hypoglycemia) risk
Sitagliptin’s risk of low blood sugar is generally low on its own. But the risk can increase when it’s combined with other diabetes medicines—especially those that can cause hypoglycemia.
Two common examples:
- Insulin
- Sulfonylureas (a class of diabetes medicines such as glipizide, glyburide, or glimepiride)
The official label notes a higher risk of hypoglycemia when sitagliptin is used with insulin secretagogues (like sulfonylureas) or with insulin, and it also describes a small increase in digoxin exposure with sitagliptin (see relevant sections in the DailyMed: Januvia (sitagliptin) label).
Cardiovascular safety: what TECOS (and later analyses) found
The TECOS trial is a landmark (foundational) cardiovascular outcomes study for sitagliptin.
In TECOS, 14,671 participants with type 2 diabetes and established cardiovascular disease were randomized to sitagliptin or placebo on top of usual care (TECOS trial in The New England Journal of Medicine).
Over a median follow-up of about 3 years, sitagliptin was noninferior to placebo for major cardiovascular events—meaning outcomes were not worse than placebo by more than a pre-set margin used in the trial.
Later, researchers revisited (“re-adjudicated”) some outcomes, which is a careful re-check of how certain events were classified (TECOS re-adjudication paper via PMC).
That paper also reports a meta-analysis (a study that pools results from multiple trials). In the pooled results, the overall estimate did not show a statistically significant increase in hospitalization for heart failure.
A more recent 2021 meta-analysis of randomized trials similarly reported a neutral effect of DPP-4 inhibitors on major cardiovascular outcomes and hospitalization for heart failure (World Journal of Cardiology meta-analysis via PMC, 2021).
Monitoring: what to track while taking sitagliptin
Monitoring is individualized, but a few basics come up again and again:
- A1C (hemoglobin A1C): a lab test that estimates your average blood sugar over roughly 2–3 months.
- CGM (continuous glucose monitoring): a CGM device can help you see day-to-day patterns (time in range, highs, lows) that A1C alone can’t show.
- How often to reassess: The American Diabetes Association’s Standards of Care in Diabetes—2026 notes that glycemic status is typically assessed at least twice yearly if goals are being met, and more often (such as every 3 months) if goals aren’t being met or treatment changes are happening (ADA Standards of Care—2026, Section 6).
Check out these BodySpec blogs for related reading:
- How much can A1C drop in 3 months?
- Insulin resistance & weight loss guide
- CGM for weight loss: a data-driven guide
Does sitagliptin cause weight loss?
Sitagliptin is generally considered weight-neutral.
In contrast, GLP-1 receptor agonists (a class of diabetes medicines that often reduce appetite and are commonly taken by injection) tend to produce weight loss for many people.
A review of head-to-head trials comparing GLP-1 receptor agonists vs. DPP-4 inhibitors (often against sitagliptin) describes DPP-4 inhibitors as generally weight-neutral, while GLP-1 receptor agonists tend to produce weight loss (with more GI side effects) (GLP-1 vs DPP-4 review via PMC).
Cost and savings: how to pay less for Januvia / sitagliptin
Prescription pricing changes constantly, but there are a few reliable places to look.
1) Check whether a generic exists
Generic availability can change over time.
In the U.S., the most reliable way to verify whether therapeutically equivalent generics (including a potential generic sitagliptin) are listed is the FDA’s Orange Book database (FDA Orange Book overview).
2) Compare pharmacy prices and coupons
GoodRx is a third-party price comparison and coupon service.
As one example snapshot, the GoodRx Januvia page showed cash prices for Januvia 100 mg (30 tablets) around the $299–$336 range across several pharmacies in one U.S. city (Atlanta) in January 2026—but prices can change quickly and vary by pharmacy and location (GoodRx: Januvia pricing).
If you want a step-by-step on how to use a coupon at the counter, see: GoodRx Guide: How to Lower Prescription Costs.
3) Manufacturer programs and patient assistance
Merck lists patient support options including coupons for some eligible privately insured patients, plus help through the Merck Access Program and referrals to the Merck Patient Assistance Program (Merck patient support programs).
For people who are uninsured and meet eligibility criteria, the Merck Patient Assistance Program page for Januvia explains how to apply and lists income limits and a phone number to start (Merck Patient Assistance Program for Januvia).
A BodySpec note: if your weight doesn’t change, body composition still can
Because sitagliptin is generally weight-neutral, it’s common for the scale to be… underwhelming. That doesn’t mean your habits aren’t working.
Many people track body composition alongside labs—because fat mass, lean mass, and visceral fat can change even when body weight barely moves.
A DEXA scan is one way to measure body composition (fat, lean mass, and visceral fat) and can complement lifestyle work—but it does not diagnose or treat diabetes. If you’re new to DEXA, start with The DEXA scan: body fat, muscle, and bone density testing.
If you want an objective baseline to track changes over time, you can book here: BodySpec scan booking.
FAQs (quick answers)
Can I take sitagliptin with food?
Yes—sitagliptin can be taken with or without food.
How long do I need to take it?
Diabetes medicines help control blood sugar but don’t “cure” diabetes, so many people take them long-term unless their clinician changes the plan.
What if I’m older?
Older adults are more likely to have reduced kidney function, which can affect dosing—so eGFR-based dosing can be especially important.
What should I do if I think I’m having side effects?
If you have severe symptoms (like severe stomach pain, blistering skin, swelling of the face/lips/tongue/throat, or trouble breathing), seek urgent medical care and contact your clinician promptly.
