Jardiance (empagliflozin) and Januvia (sitagliptin) are commonly used together for type 2 diabetes. The two medications work by completely different mechanisms — Jardiance causes the kidney to excrete glucose, while Januvia increases the body’s own insulin response after meals. Combined, they typically lower A1C by 1.5 to 2.0 percent — additive rather than overlapping. Both are oral once-daily tablets, generally well-tolerated, with low hypoglycemia risk.
What Each Drug Is
| Feature | Jardiance | Januvia |
|---|---|---|
| Active ingredient | Empagliflozin | Sitagliptin |
| Drug class | SGLT2 inhibitor | DPP-4 inhibitor |
| Manufacturer | Boehringer Ingelheim / Lilly | Merck |
| FDA approval year | 2014 | 2006 |
| Available doses | 10 mg, 25 mg | 25 mg, 50 mg, 100 mg |
| Frequency | Once daily | Once daily |
| A1C reduction | 0.7 to 1.0 percent | 0.7 to 0.8 percent |
| Weight effect | Loss 2 to 3 kg | Weight neutral |
| Blood pressure | Reduces 3 to 5 mmHg | Neutral |
| Hypoglycemia risk | Very low alone | Very low alone |
How They Work Together
- Jardiance — blocks SGLT2 in the kidney, causing 50 to 80 grams of glucose to be excreted in urine each day. Independent of pancreatic function.
- Januvia — inhibits the enzyme DPP-4, which normally breaks down GLP-1 and GIP (incretin hormones). With Januvia, GLP-1 and GIP last longer, leading to more insulin secretion when glucose is high and less glucagon release. Effect is glucose-dependent.
- Combined effect — lower glucose enters the bloodstream from the gut and liver (Januvia), while excess glucose already there is excreted (Jardiance)
- No overlap in mechanism means full additive A1C reduction
- Both glucose-dependent, so minimal hypoglycemia risk together
Dosing
- Jardiance — 10 mg or 25 mg once daily, morning, with or without food
- Januvia — 100 mg once daily; 50 mg if eGFR 30 to 44; 25 mg if eGFR under 30
- Both can be taken at the same time
- No dose interaction between them
- Adjust Januvia for kidney function; adjust Jardiance only at very low eGFR
Expected Combined Effects
| Outcome | Jardiance Alone | Januvia Alone | Combined |
|---|---|---|---|
| A1C reduction | 0.7 to 1.0 percent | 0.7 to 0.8 percent | 1.5 to 2.0 percent |
| Fasting glucose | Drops 20 to 30 mg/dL | Drops 15 to 20 mg/dL | Drops 35 to 50 mg/dL |
| Weight | Loss 2 to 3 kg | Neutral | Loss 2 to 3 kg |
| Blood pressure | Drops 3 to 5 mmHg | Neutral | Drops 3 to 5 mmHg |
| Hypoglycemia (no insulin / SU) | Low | Low | Low |
| CV mortality data | Strong (EMPA-REG) | Neutral | Driven by Jardiance |
Who Is a Good Candidate
- Type 2 diabetes with A1C still above goal on metformin alone
- Patients who want oral therapy and prefer to avoid injections
- Patients with high hypoglycemia risk (history, kidney disease, elderly)
- Patients with mild to moderate kidney impairment
- Type 2 diabetes plus cardiovascular disease or heart failure (Jardiance benefit)
- Patients with weight loss as a goal (Jardiance benefit)
- Patients who do not tolerate sulfonylureas or GLP-1 agonists
Who Should Be Cautious
- Type 1 diabetes — Jardiance not approved due to DKA risk
- History of pancreatitis — caution with Januvia (rare risk)
- History of bullous pemphigoid — DPP-4 inhibitors can rarely trigger or worsen
- Severe kidney impairment — both require dose review
- Heart failure with known DPP-4 sensitivity (saxagliptin had a HF signal; sitagliptin did not but caution remains)
- Recurrent genital or UTI infections
Side Effects Side by Side
| Side Effect | From Jardiance | From Januvia |
|---|---|---|
| Genital yeast infection | 8 to 12 percent | Not typical |
| Urinary tract infection | 5 to 9 percent | Slight increase |
| Dehydration / dizziness | 1 to 3 percent | Not typical |
| Pancreatitis | Not associated | Rare |
| Joint pain | Not typical | Rare |
| Allergic / skin reactions | Rare | Rare (Stevens-Johnson, angioedema) |
| Euglycemic DKA | Less than 0.1 percent | Not associated |
| Heart failure | Reduces risk | Neutral (sitagliptin specifically) |
Combining With Metformin
Most patients are on metformin already, so the combination is typically metformin + Jardiance + Januvia — a three-drug oral regimen. Metformin reduces hepatic glucose output, Jardiance reduces glucose reabsorption in the kidney, and Januvia enhances insulin secretion. The three add up to substantial A1C reduction with low hypoglycemia risk. Cost is the main barrier — until generics arrive, this is an expensive combination unless covered by insurance.
Fixed-Dose Combination Products
- Glyxambi — empagliflozin + linagliptin (Jardiance class + Tradjenta class, very similar combination concept)
- Trijardy XR — empagliflozin + linagliptin + metformin (three drugs in one tablet)
- Janumet — sitagliptin + metformin (Januvia + metformin combination)
- Synjardy — empagliflozin + metformin
- No single tablet combines empagliflozin + sitagliptin specifically
Cost Considerations
- Jardiance — about $540 to $580 per month US retail
- Januvia — about $590 to $640 per month US retail
- Combined retail — roughly $1,100 to $1,200 per month before insurance
- Manufacturer copay cards — can reduce to under $25 per month each for commercially insured patients
- Medicare Part D — Inflation Reduction Act negotiated pricing applies to Jardiance starting 2026
- No US generics for either as of 2026
Monitoring
- A1C every 3 months until at goal, then every 6 months
- Kidney function annually, more often if borderline
- Blood pressure each visit
- Weight each visit
- Watch for genital or urinary infections (Jardiance side)
- Watch for severe abdominal pain (potential pancreatitis from Januvia)
- Check ketones if DKA symptoms (nausea, vomiting, fast breathing) even at normal glucose
Related Reading
See our treatment hub, Is Jardiance for diabetes, and the A1C levels guide. For Januvia detail, see the Januvia prescribing information.
The Bottom Line
Jardiance and Januvia can be taken together and are a common combination for type 2 diabetes. Their mechanisms are complementary — Jardiance causes glucose excretion in urine, Januvia enhances glucose-dependent insulin secretion. Combined A1C reduction is typically 1.5 to 2.0 percent. Both are oral once-daily tablets. The pairing is generally well-tolerated with very low hypoglycemia risk. Side effects include Jardiance’s yeast infections and Januvia’s rare pancreatitis. Cost is significant — about $1,100 per month at retail without insurance — though copay cards help. Talk to your doctor about whether this combination fits your A1C goals, cardiovascular and kidney risk, and budget.
