Juvisync | sitagliptan and simvastatin

Medication Class: dipeptidyl peptidase-4 (DPP-4) and HMG-CoA reductase inhibitor (statin)
Manufacturer: Merck
Approval date: October 2011; Discontinued September 2013

What is Juvisync and how does it work

Juvisync is a combination pill that contains 100 mg of sitagliptin (Januvia) and 10, 20, or 40 mg of simvastatin (Zocor). Sitagliptin reduces blood glucose in individuals with type 2 diabetes by inhibiting the enzyme dipeptidyl peptidase-4 (DPP-4). Simvastatin is a cholesterol reducer that works by inhibiting the enzyme HMG-CoA reductase which is needed for the production of cholesterol in the liver.

What does Juvisync treat

Juvisync is used for treating individuals with type 2 diabetes who also require treatment with simvastatin due to elevated cholesterol, triglycerides, or a high risk of events related to heart disease.

Merck announced on September 26, 2013 that it will stop distribution and sale of Juvisync in the US for business reasons. The discontinuation is not due to safety or efficacy of Juvisync. 

How effective is Juvisync

Juvisync is expected to have the same effectiveness as the individual components (sitagliptin and simvastatin).

Sitagliptin

• Januvia reduced hemoglobin A1C by -0.6% after 24 weeks while A1C increased by 0.2% in the placebo group.
• 36% of individuals treated with Januvia achieved A1C less than 7% after 24 weeks compared to 14% of individuals treated with placebo.

Simvastatin

• Reduces LDL cholesterol by 26-47%
• Reduces triglycerides by 12-33%
• Increases HDL (good cholesterol) by 10-16%
• Reduces the risk of death from coronary heart disease, reducing non-fatal heart attack and stroke, and reducing the need for coronary and non-coronary revascularization procedures.

What are interesting facts about Juvisync

• It combines two medications that are commonly used by patients with type 2 diabetes into one pill.
• Those who require sitagliptin 25 or 50 mg cannot use Juvisync because that dosage combination is not currently available.
• It is the first pill that combines a glucose reducing medication with a cholesterol reducing medication.

How is Juvisync dosed and administered

The recommended dose is one tablet by mouth once daily in the evening. Recommended starting dose is 100/40 mg or based on the dose of simvastatin currently being used (i.e., if taking 10, 20, or 40 mg of simvastatin then use the corresponding dose of Juvisync).

What are the side effects of Juvisync

Juvisync has the same side effects as its components.

Sitagliptin side effects

Common: Stomach upset, diarrhea, runny nose, sore throat, upper respiratory infection, headache.

Serious: Pancreatitis, allergic reactions (hives, rash, swelling of lips, face, throat and tongue).

Simvastatin side effects

Common: Nausea, vomiting, diarrhea, abdominal pain, headache, muscle pain, and abnormal liver tests.

Serious: Liver damage, rhabdomyolysis, kidney failure, pancreatitis.

Juvisync drug interactions

Juvisync has the same drug interactions as its components. These drug interactions result mostly from the simvastatin component. Combining Juvisync with other drugs that reduce blood glucose may increase the frequency of hypoglycemia (low blood glucose).

Large quantities of grape fruit juice (>1 quart daily), erythromycin (E-Mycin), clarithromycin (Biaxin), telithromycin (Ketek), ketoconazole (Nizoral), itraconazole (Sporanox), posaconazole (Noxafil), HIV protease inhibitors (Crixivan, Norvir), danazol (Danocrine), cyclosporine (Sandimmune), amiodarone (Cordarone), ranolazine (Ranexa), verapamil (Calan), diltiazem (Cardizem), amlodipine (Norvasc), niacin (Niaspan), gemfibrozil (Lopid), and fenofibrate (Tricor), warfarin (Coumadin), cholestyramine.

What was the price of Juvisync

Juvisync will cost about $215 per month which is about the same cost as Januvia alone.

References: Juvisync FDA Prescribing Information and Medication Guide.

Additional Resources: Januvia | Janumet | Zocor

This medication summary is for information only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider.

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