Januvia vs. Amaryl
See how Januvia and Amaryl compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Januvia is a DPP-4 inhibitor with a low risk of hypoglycemia, while Amaryl is a sulfonylurea that can cause hypoglycemia and weight gain.
Amaryl is available as an inexpensive generic, while Januvia is a brand-name drug with a much higher typical monthly cost.
Both drugs are approved as add-ons to diet and exercise for type 2 diabetes, and neither is approved for type 1 diabetes or diabetic ketoacidosis.
Januvia vs. Amaryl Drug Summary
Januvia
Januvia (sitagliptin) is a DPP-4 inhibitor used to improve blood sugar control in adults with type 2 diabetes. It is taken as a single tablet once a day, with the dose adjusted for kidney function. It is typically added to diet and exercise and can be combined with other diabetes medications.
Amaryl
Amaryl (glimepiride) is a sulfonylurea used to improve blood sugar control in adults with type 2 diabetes. It is taken as a single tablet once a day, with the dose slowly increased over time to find the right amount. It works by helping the pancreas release more insulin and is available as an inexpensive generic.
Januvia vs. Amaryl Side Effects
Januvia
Amaryl
Januvia vs. Amaryl Dosage
Januvia
Amaryl
| STAGE | DOSE | WHEN |
| Starting dose | 100 mg once daily | At the start |
| Maximum dose | 25 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg or 2 mg once daily | At the start |
| Maximum dose | 8 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Januvia
| STAGE | DOSE | WHEN |
| Starting dose | 100 mg once daily | At the start |
| Maximum dose | 25 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Amaryl
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg or 2 mg once daily | At the start |
| Maximum dose | 8 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Januvia vs. Amaryl Indications
Januvia
Januvia is FDA-approved as an add-on to diet and exercise for adults with type 2 diabetes who need additional blood sugar control. It works by raising levels of natural incretin hormones, which helps the pancreas release insulin when blood sugar rises. It is not approved for type 1 diabetes or diabetic ketoacidosis.
Adjunct to diet and exercise in type 2 diabetes
Can be used alone or with other oral diabetes drugs
Not approved for type 1 diabetes or ketoacidosis
Dose adjusted for reduced kidney function
Amaryl
Amaryl is FDA-approved as an add-on to diet and exercise for adults with type 2 diabetes who need better blood sugar control. It works by stimulating the pancreas to release more insulin and can be combined with insulin in patients who don't respond well to either alone. It is not approved for type 1 diabetes or diabetic ketoacidosis.
Adjunct to diet and exercise in type 2 diabetes
Only sulfonylurea approved for use with insulin
Not approved for type 1 diabetes or ketoacidosis
Requires periodic dose titration over time
Januvia vs. Amaryl Pros and Cons
Januvia
Januvia offers a low risk of hypoglycemia and a weight-neutral profile, making it a reasonable option for patients who cannot tolerate sulfonylurea side effects. As a brand-name DPP-4 inhibitor, it costs considerably more each month than older generic options and needs dose adjustments based on kidney function.
Pros
Weight-neutral, unlike drugs that often cause weight gain
Low risk of hypoglycemia when used on its own
No routine blood sugar monitoring needed for dosing
No boxed warning, unlike some other diabetes drug classes
Cons
Roughly $330 to $730 per month without insurance, before savings programs
Dose must be adjusted for reduced kidney function
Postmarketing reports of severe joint pain and pancreatitis
Fewer decades of long-term safety data than older drugs
Amaryl
Amaryl is an inexpensive, well-established sulfonylurea with decades of use behind it, though it carries a real risk of hypoglycemia and weight gain. Its low cost and long-standing generic availability make it a common choice for patients watching their budget.
Pros
Roughly $15 to $110 per month without insurance, before savings programs
Decades of real-world safety data since its 1995 approval
Flexible once-daily dosing that can be titrated to effect
Can be combined with insulin when other options fail
Cons
Can cause hypoglycemia, sometimes severe
Often associated with weight gain
Older studies raised concerns about cardiovascular mortality
Requires caution in patients with G6PD deficiency
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