| Diabetes Mellitus, Non-Insulin-Dependent
Cycloset vs Janumet
Side-by-side clinical, coverage, and cost comparison for diabetes mellitus, non-insulin-dependent.Deep comparison between: Cycloset vs Janumet with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsJanumet has a higher rate of injection site reactions vs Cycloset based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Janumet but not Cycloset, including UnitedHealthcare
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Category
Cycloset
Janumet
At A Glance
Oral
Daily
Dopamine D2 receptor agonist
Oral
Twice daily
DPP-4 inhibitor / biguanide combination
Indications
- Diabetes Mellitus, Non-Insulin-Dependent
- Diabetes Mellitus, Non-Insulin-Dependent
Dosing
Diabetes Mellitus, Non-Insulin-Dependent 1.6 mg to 4.8 mg once daily within 2 hours after waking in the morning with food; initiate at 0.8 mg, increase by one tablet per week to maximal tolerated dose; limit to 1.6 mg daily with moderate CYP3A4 inhibitors; avoid with strong CYP3A4 inhibitors.
Diabetes Mellitus, Non-Insulin-Dependent 50 mg sitagliptin/500 mg metformin HCl twice daily with meals as starting dose for patients not on metformin; for patients on metformin HCl 850 mg twice daily, start at 50 mg sitagliptin/1000 mg metformin HCl twice daily; max 100 mg sitagliptin/2000 mg metformin HCl daily; do not split or divide tablets.
Contraindications
- Known hypersensitivity to bromocriptine, ergot-related drugs, or any excipient in CYCLOSET
- Syncopal migraine
- Postpartum patients
- Lactating patients
- Severe renal impairment (eGFR below 30 mL/min/1.73 m2)
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis
- History of a serious hypersensitivity reaction to JANUMET, sitagliptin, or metformin, such as anaphylaxis or angioedema
Adverse Reactions
Most common (>=5%) Nausea, fatigue, vomiting, headache, dizziness, rhinitis, constipation, sinusitis, diarrhea, asthenia, somnolence, dyspepsia, amblyopia, anorexia
Serious Hypotension, psychotic disorders, somnolence, syncope, fibrotic-related complications, cardiovascular events (myocardial infarction, stroke)
Postmarketing Hallucinations, retroperitoneal fibrosis, pulmonary fibrosis, pleural effusion, pericarditis, pericardial effusions, cardiac valvulopathy, psychotic and psychiatric disorders, impulse control/compulsive behaviors, neuroleptic-like malignant syndrome
Most common (>=5%) Diarrhea, upper respiratory tract infection, headache, nasopharyngitis, nausea/vomiting, flatulence, abdominal discomfort, indigestion, asthenia
Serious Lactic acidosis, pancreatitis, heart failure, acute renal failure, hypoglycemia (with sulfonylurea or insulin), hypersensitivity reactions, severe and disabling arthralgia, bullous pemphigoid
Postmarketing Anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis, Stevens-Johnson syndrome, hepatic enzyme elevations, fatal and non-fatal hemorrhagic and necrotizing pancreatitis, worsening renal function, acute renal failure, tubulointerstitial nephritis, rhabdomyolysis, constipation, myalgia, back pain, pruritus, mouth ulceration, cholestatic and hepatocellular liver injury
Pharmacology
CYCLOSET (bromocriptine mesylate) is a sympatholytic dopamine D2 receptor agonist; timed morning administration in type 2 diabetes is associated with increased insulin sensitivity and glucose disposal and reduced fasting and postprandial hyperglycemia without raising plasma insulin levels.
Sitagliptin is a DPP-4 inhibitor that slows inactivation of incretin hormones GLP-1 and GIP, increasing insulin release and decreasing glucagon in a glucose-dependent manner; metformin is a biguanide that decreases hepatic glucose production, reduces intestinal glucose absorption, and improves peripheral insulin sensitivity by increasing glucose uptake and utilization.
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Most Common Insurance
Anthem BCBS
Cycloset
- Covered on 5 commercial plans
- PA (4/12) · Step Therapy (2/12) · Qty limit (6/12)
Janumet
- Covered on 5 commercial plans
- PA (1/12) · Step Therapy (9/12) · Qty limit (11/12)
UnitedHealthcare
Cycloset
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Janumet
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (2/8)
Humana
Cycloset
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (2/3) · Qty limit (2/3)
Janumet
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Cycloset.
No savings programs available for Janumet.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.