Januvia vs Ozempic: Sitagliptin vs Semaglutide | Dose Track
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[Diabetes · Comparison]

Januvia vs Ozempic: how do sitagliptin and semaglutide compare?

Mechanism · Approved uses · Dosing · SUSTAIN 2

Short answer: Januvia (sitagliptin) is a daily tablet that slows the breakdown of the body's own GLP-1; Ozempic (semaglutide) is a weekly injection that acts on the GLP-1 receptor directly.12 In SUSTAIN 2, a head-to-head trial, HbA1c fell 1.3% to 1.6% on semaglutide vs 0.5% on sitagliptin over 56 weeks, and weight fell 4.3 to 6.1 kg vs 1.9 kg.3

How do Januvia and Ozempic compare side by side?

From the US Januvia and Ozempic labels; trial rows from SUSTAIN 2.
Januvia (sitagliptin)Ozempic (semaglutide)
Drug classDPP-4 inhibitor1GLP-1 receptor agonist2
FormTablet once a day, with or without food1Injection under the skin once a week2
Approved forBlood sugar control in adults with type 2 diabetes1Blood sugar control in adults with type 2 diabetes; lowering heart attack, stroke and cardiovascular death in those with heart disease; slowing kidney decline in those with kidney disease2
Label dosing100 mg a day; 50 mg if eGFR 30 to under 45; 25 mg if under 30 or on dialysis10.25 mg a week for 4 weeks, then 0.5 mg; may go to 1 mg, then 2 mg at most2
Half-lifeAbout 12.4 hours1About 1 week; present for about 5 weeks after the last dose2
Boxed warningNone1Thyroid C-cell tumors in rodents; not used with a personal or family history of medullary thyroid cancer or MEN 22
Most common side effects (5% or more)Upper respiratory infection, stuffy or runny nose and sore throat, headache1Nausea, vomiting, diarrhea, stomach pain, constipation2
SUSTAIN 2: HbA1c change, 56 weeks−0.5% (100 mg)3−1.3% (0.5 mg) and −1.6% (1 mg)3
SUSTAIN 2: weight change−1.9 kg3−4.3 kg (0.5 mg) and −6.1 kg (1 mg)3
SUSTAIN 2: stopped for side effects3%38% (0.5 mg) and 10% (1 mg)3

Reviewed . Half-life figures are shown only where the value Dose Track uses agrees with the cited source.

How do they work differently?

After a meal the gut releases GLP-1 and GIP, which help the body release insulin. Sitagliptin blocks DPP-4, the enzyme that breaks these hormones down, so the body's own GLP-1 lasts longer.1 Semaglutide is a long-acting copy of GLP-1 that acts on the receptor itself, with a half-life of about a week.2

What did SUSTAIN 2 compare?

SUSTAIN 2 randomized 1,231 adults with type 2 diabetes who were already on metformin, a thiazolidinedione (such as pioglitazone), or both. They got weekly semaglutide 0.5 mg or 1 mg, or daily sitagliptin 100 mg, for 56 weeks. It was double blind: everyone took both a shot and a pill, one of them a placebo.3

  • HbA1c (starting average 8.1%): down 1.3% and 1.6% on semaglutide vs 0.5% on sitagliptin.3
  • Weight (starting average 89.5 kg): down 4.3 kg and 6.1 kg vs 1.9 kg.3
  • Nausea: 18% in each semaglutide group vs 7% in the sitagliptin group. Diarrhea: 13% vs 7%.3
  • Low blood sugar confirmed by a glucose reading: 2%, under 1% and 1%.3

The trial was paid for by Novo Nordisk, which makes semaglutide.3

What warnings stand out on each label?

  • Januvia: acute pancreatitis, including fatal cases; heart failure seen with two other drugs in its class; kidney problems; serious allergic reactions; severe joint pain; and bullous pemphigoid, a blistering skin condition.1
  • Ozempic: a boxed warning about thyroid C-cell tumors in rodents. Most stomach side effects happened while the dose was being raised; in placebo-controlled trials 32.7% (0.5 mg) and 36.4% (1 mg) had stomach and gut side effects vs 15.3% on placebo.2

More detail: Ozempic side effects, the Ozempic dosing schedule, and the Sitagliptin and Semaglutide guides.

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Frequently asked questions

Is Januvia a GLP-1 drug?+
No. Januvia (sitagliptin) is a DPP-4 inhibitor. It raises the body's own GLP-1 by slowing the enzyme that breaks it down. Ozempic acts on the GLP-1 receptor directly.12
Have Januvia and Ozempic been compared directly?+
Yes. In SUSTAIN 2, over 56 weeks, HbA1c fell 1.3% (0.5 mg) and 1.6% (1 mg) on semaglutide vs 0.5% on sitagliptin 100 mg, and weight fell 4.3 kg and 6.1 kg vs 1.9 kg.3
Which has more stomach side effects?+
In SUSTAIN 2, nausea was reported by 18% in each semaglutide group vs 7% in the sitagliptin group, and more people stopped semaglutide for side effects (8% and 10% vs 3%).3
Does Januvia need a lower dose with kidney disease?+
Yes. The label lowers it to 50 mg a day when eGFR is 30 to under 45, and to 25 mg when eGFR is under 30 or on dialysis.1
Can I track Januvia and Ozempic in Dose Track?+
Yes. Log the daily tablet and the weekly shot together, with reminders for each.

Sources

  1. Januvia (sitagliptin) tablets prescribing information, sections 1, 2, 3, 5, 6.1, 12.3 and 14. DailyMed, version 71.
  2. Ozempic (semaglutide) injection prescribing information. DailyMed, revised June 2026.
  3. Ahrén B, et al. Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial. Lancet Diabetes Endocrinol. 2017;5:341-354.

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