Januvia vs. Invokana
See how Januvia and Invokana compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Januvia is a once-daily DPP-4 inhibitor pill for type 2 diabetes, while Invokana is a once-daily SGLT2 inhibitor pill that also protects the heart and kidneys.
Invokana carries added FDA approvals for reducing cardiovascular events and slowing kidney disease progression, benefits Januvia does not have.
Januvia's most common side effects are respiratory infections and swelling, while Invokana's are genital yeast infections and urinary symptoms tied to how it removes sugar through urine.
Januvia vs. Invokana Drug Summary
Januvia
Januvia (sitagliptin) is a DPP-4 inhibitor used to improve blood sugar control in adults with type 2 diabetes. It's taken as a single oral tablet once a day, with or without food, often alongside diet and exercise or other diabetes medications.
Invokana
Invokana (canagliflozin) is an SGLT2 inhibitor used to improve blood sugar control in adults and children 10 and older with type 2 diabetes. It's taken as a single oral tablet once daily before the first meal, and it also lowers cardiovascular and kidney disease risk in certain patients.
Januvia vs. Invokana Side Effects
Januvia
Invokana
Januvia vs. Invokana Dosage
Januvia
Invokana
| 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 | 100 mg once daily | At the start |
| Maximum dose | 300 mg once daily | If needed |
| Dose changes | 1 increase | 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 |
Invokana
| STAGE | DOSE | WHEN |
| Starting dose | 100 mg once daily | At the start |
| Maximum dose | 300 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Januvia vs. Invokana Indications
Januvia
Januvia is prescribed as an adjunct to diet and exercise to improve blood sugar control in adults with type 2 diabetes. It can be used alone or combined with other oral diabetes medicines or insulin. It is not approved for type 1 diabetes or diabetic ketoacidosis.
Adjunct to diet and exercise for type 2 diabetes
Can be combined with metformin or other oral agents
Once-daily oral tablet, no titration needed
Not approved for type 1 diabetes
Not approved for diabetic ketoacidosis
Invokana
Invokana is approved as an adjunct to diet and exercise to improve blood sugar control in adults and children 10 and older with type 2 diabetes. It also carries FDA approval to reduce the risk of major cardiovascular events in adults with heart disease and to slow the progression of diabetic kidney disease. It is not approved for type 1 diabetes.
Adjunct to diet and exercise for type 2 diabetes
Reduces cardiovascular event risk in heart disease
Slows progression of diabetic kidney disease
Approved for patients ages 10 and older
Not approved for type 1 diabetes
Januvia vs. Invokana Pros and Cons
Januvia
Januvia has a long track record since its 2006 approval and a simple once-daily dosing schedule with no titration required. It's generally weight-neutral and carries a lower risk of genitourinary side effects than SGLT2 inhibitors, but it offers no proven heart or kidney protection.
Pros
Simple once-daily dosing with no titration steps
Weight-neutral, doesn't typically cause weight gain
Low risk of genitourinary infections
On the market since 2006 with long safety experience
Cons
No proven cardiovascular or kidney protection benefit
Dose must be adjusted for reduced kidney function
Postmarketing reports of severe joint pain and pancreatitis
Risk of bullous pemphigoid, a serious skin reaction
Invokana
Invokana adds proven cardiovascular and kidney protection to its blood-sugar-lowering effect, which sets it apart from older oral diabetes drugs. That added benefit comes with a real trade-off: higher rates of genital yeast infections and a small but serious risk of Fournier's gangrene.
Pros
Reduces cardiovascular event risk in heart disease
Slows progression of diabetic kidney disease
Can lead to modest weight loss
Approved for adolescents as young as 10
Cons
Higher risk of genital yeast infections in both sexes
Rare but serious risk of Fournier's gangrene
Contraindicated in severe kidney impairment
Can increase risk of dehydration and low blood pressure
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