I have been taking Januvia 100 mg once daily for about two years and have developed increasingly severe joint pain in my knees, hips, elbows and thumbs.
I have seen orthopedic and arthritis specialists and tried anti-inflammatory medicines without much relief. I can hardly walk because of the pain.
Could Januvia be causing this, and are there natural alternatives for treating my type 2 diabetes?
Answer by Dr. Albana Greca Sejdini, MD, MMedSc, Family Physician, IDF Fellow
Hello,
Yes, Januvia can cause severe joint pain, and your symptoms are serious enough that this possibility should be reviewed promptly.
Yes. Januvia contains sitagliptin, which belongs to the DPP-4 inhibitor class of diabetes medicines.
The FDA has received reports of severe and disabling joint pain with DPP-4 inhibitors. Symptoms have started anywhere from a day to several years after treatment began.
In reported cases, joint pain often improved after the medicine was discontinued, and some people developed the pain again when the same or another DPP-4 inhibitor was restarted.
Do not stop Januvia on your own unless a clinician tells you to do so or you are having a medical emergency.
Your prescriber can review your glucose control, HbA1c, kidney function and other medicines and decide whether Januvia should be stopped or replaced with another diabetes treatment.
If sitagliptin is suspected, your clinician may also consider whether another DPP-4 inhibitor should be avoided.
Yes. Not all joint pain in someone taking Januvia is caused by the drug.
Other possibilities include osteoarthritis, inflammatory arthritis, gout, autoimmune disease, tendon problems or another medication effect.
Because your pain involves several joints and is severe, a rheumatology review may still be useful, especially if you have swelling, warmth, prolonged morning stiffness, fever or other systemic symptoms.
Anti-inflammatory drugs can help some types of joint pain, but they do not solve the problem if the underlying cause is a medication reaction.
They also need to be used carefully in people with kidney disease, stomach ulcers, cardiovascular disease or other risk factors.
So I would focus first on clarifying the cause of the pain rather than simply escalating pain medication.
I would not replace Januvia with herbs or supplements on your own.
Products such as cinnamon, bitter melon, Gymnema or fenugreek have been studied, but current evidence is not strong enough to recommend them as substitutes for proven diabetes medicines.
Some supplements can also interact with medications or affect the liver, kidneys or glucose levels.
Lifestyle treatment is still important, but it should be individualized rather than based on a fixed 1200-calorie diet or a rule that everyone should run every day.
Useful measures can include:
Since you currently have severe joint pain, low-impact activity such as short walks, cycling, swimming or chair-based exercise may be more realistic than running or weight-bearing exercise until the cause is clarified.
Your joint pain should not be dismissed. Januvia is a plausible cause because severe disabling arthralgia is a recognized adverse effect of DPP-4 inhibitors.
I would contact your prescribing clinician soon, explain that the pain is now limiting your ability to walk, and ask specifically whether sitagliptin should be discontinued and replaced.
At the same time, continue the rheumatologic evaluation if the cause remains uncertain.
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