Short answer: Both are once-daily DPP-4 inhibitors for blood sugar in adults with type 2 diabetes, taken with or without food.12 Nesina (alogliptin) is 25 mg, cut to 12.5 or 6.25 mg by kidney function. Januvia (sitagliptin) is 100 mg, cut to 50 or 25 mg. Nesina adds a liver warning. Neither has a boxed warning or reports a trial against the other.
| Nesina | Januvia | |
|---|---|---|
| Drug | Alogliptin1 | Sitagliptin2 |
| Usual dose | 25 mg once daily, with or without food; tablets not split1 | 100 mg once daily, with or without food2 |
| Moderate kidney impairment | 12.5 mg once daily at a CrCl of 30 to under 60 mL/min1 | 50 mg once daily at an eGFR of 30 to under 452 |
| Severe impairment or dialysis | 6.25 mg once daily1 | 25 mg once daily2 |
| Side effects in label trials | Stuffy or runny nose 5% vs 4% on placebo; headache 4% vs 3%1 | Used alone: stuffy or runny nose 5.2% vs 3.3% on placebo2 |
| Heart failure | Hospital stays 3.9% vs 3.3% on placebo in EXAMINE1 | Seen with two other DPP-4 inhibitors2 |
| Missed dose | Do not double; the Medication Guide says take when remembered unless the next dose is due1 | Medication Guide: take when remembered; skip if the next dose is due2 |
| Boxed warning | None1 | None2 |
Both labels list pancreatitis, heart failure, allergic reactions, low blood sugar with insulin or a sulfonylurea, severe joint pain and bullous pemphigoid.12 Nesina adds liver effects: fatal and non-fatal liver failure has been reported, and Nesina is interrupted if liver tests are abnormal.1 Januvia adds acute kidney failure, some in people given doses too high for their kidney function.2 On its own, low blood sugar was 1.5% on Nesina vs 1.6% on placebo, and 1.2% on Januvia vs 0.9% on placebo. These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Nesina side effects, Januvia side effects, the Nesina and Januvia dosing schedules, the Januvia missed-dose page and Januvia vs Tradjenta: how do the two DPP-4 tablets differ?.