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

Most common
upper respiratory tract infection (up to 15.5%)
nasopharyngitis (up to 11.0%)
peripheral edema (up to 8.3%)
headache (up to 5.5%)

Invokana

Most common
female genital mycotic infection (up to 11.6%)
urinary tract infection (up to 5.9%)
increased urination (up to 5.3%)
male genital mycotic infection (up to 4.2%)

Januvia vs. Invokana Dosage

Januvia

Dosage
Dosage Table
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

Dosage
Dosage Table
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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