Sitagliptin

Sitagliptin Uses, Dosage, Side Effects, Food Interaction and all others data.

The DPP-4 inhibitors are a class of agents that act as incretin enhancers. By inhibiting the DPP-4 enzyme, Sitagliptin increases the levels of two known active incretin hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells. GLP-1 also lowers glucagon secretion from pancreatic alpha cells, leading to reduced hepatic glucose production. This mechanism is unlike the mechanism seen with sulfonylureas; sulfonylureas cause insulin release even when glucose levels are low, which can lead to sulfonylurea-induced hypoglycemia in patients with type ll diabetes and in normal subjects. Sitagliptin demonstrates high selectivity for DPP-4 and does not inhibit closely-related enzymes DPP-8 or DPP-9 at therapeutic concentrations.

Sitagliptin inhibits DPP-4 which leads to increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide(GIP), decreased levels of glucagon, and a stronger insulin response to glucose.

Trade Name Sitagliptin
Availability Prescription only
Generic Sitagliptin
Sitagliptin Other Names Sitagliptin, Sitagliptina, Sitagliptine, Sitagliptinum
Related Drugs Farxiga, metformin, Trulicity, Lantus, Victoza, Tresiba, Levemir
Weight 100mg, 25mg, 50mg
Type Oral tablet
Formula C16H15F6N5O
Weight Average: 407.3136
Monoisotopic: 407.118079357
Protein binding

38%.

Groups Approved, Investigational
Therapeutic Class Dipeptidyl Peptidase-4 (DPP-4) inhibitor
Manufacturer
Available Country United States
Last Updated: September 19, 2023 at 7:00 am
Sitagliptin
Sitagliptin

Uses

Monotherapy: Sitagliptin is used for an adjunct to diet and exercise to improve glycemic control in patients with type ll diabetes mellitus.

Combination with Metformin: Sitagliptin is used for patients with type 2 diabetes mellitus to improve glycemic control in combination with Metformin as initial therapy or when the single agent alone, with diet and exercise, does not provide adequate glycemic control.

Combination with a Sulfonylurea: Sitagliptin is used for patients with type ll diabetes mellitus to improve glycemic control in combination with a sulfonylurea when treatment with the single agent alone, with diet and exercise, does not provide adequate glycemic control.

Combination with a Thiazolidinediones: Sitagliptin is used for patients with type ll diabetes mellitus to improve glycemic control in combination with a thiazolidinedi- one when treatment with the single agent alone, with diet and exercise, does not provide adequate glycemic control.

Combination with Metformin and a Sulfonylurea: Sitagliptin is used for patients with type ll diabetes mellitus to improve glycemic control in combination with Metformin and a sulfonylurea when dual therapy with these agents, with diet and exercise, does not provide adequate glycemic control.

Sitagliptin is also used to associated treatment for these conditions: Type 2 Diabetes Mellitus

How Sitagliptin works

Inhibition of DPP-4 by sitagliptin slows DPP-4 mediated inactivation of incretins like GLP-1 and GIP. Incretins are released throughout the day and upregulated in response to meals as part of glucose homeostasis. Reduced inhibition of incretins increase insulin synthesis and decrease glucagon release in a manner dependant on glucose concentrations. These effects lead to an overall increase in blood glucose control which is demonstrated by reduced glycosylated hemoglobin (HbA1c).

Dosage

Sitagliptin dosage

The recommended dose of Sitagliptin is 100 mg once daily as monotherapy or as combination therapy with Metformin, a sulfonylurea, a thiazolidinedione, or Metformin plus a sulfonylurea. Sitagliptin can be taken with or without food.

Elderly: No dosage adjustment is required based solely on age. The drug is excreted by the kidney. As elderly patients are more likely to have decreased renal function, caution should be taken in dose selection in the elderly.

Pediatric use: There is no data on use of Sitagliptin in patients younger than 18 years of age and therefore not recommended.

Side Effects

The most common adverse reactions are; upper respiratory tract infection, nasopharyngitis and headache. Hypoglycemia may occur in patients treated with the combination of Sitagliptin and sulfonylurea and add-on to insulin.

Toxicity

Animal studies in pregnancy have shown no adverse effects on the mother or offspring at normal doses, however these results are not always applicable to humans. There is currently a voluntary registry of fetal exposure. Animal studies at 100 times the maximum recommended human dose resulted in an increase in rib malformations. Sitagliptin is excreted in the milk of rats but it is not known if it would also be expressed in human breast milk. Because many drugs are expressed in human breast milk, the risk and benefit of prescribing the medication must be considered. There is currently a lack of safety and effectiveness data in pediatric patients. No differences in safety and efficacy were observed in geriatric patients compared to younger patients, however caution should be used in this population as they are more likely to have reduced renal function. Sitagliptin has also been associated with a 34% relative risk increase for all cause infection. There was no significant difference in patient response across sex, age, race, ethnicity, and BMI.

Precaution

Sitagliptin should not be used in patients with type l diabetes or for the treatment of diabetic ketoacidosis. Dosage adjustment is recommended in patients with moderate or severe renal insufficiency and in patients with ESRD. Assessment of renal function is recommended prior to initiating Sitagliptin and periodically thereafter. When used with a sulfonylurea, a lower dose of sulfonylurea may be required to reduce the risk of hypoglycemia. There have been post marketing reports of serious allergic and hypersensitivity reactions in patients treated with Sitagliptin such as anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. In such cases, promptly stop Sitagliptin, assess for other potential causes, and institute appropriate monitoring and treatment, and initiate alternative treatment for diabetes. There have been no clinical studies establishing conclusive evidence of macrovascular risk.

Interaction

Co-administration of Digoxin and Sitagliptin may slightly increase the mean peak drug concentration of Digoxin. But no dosage adjustment of Digoxin or Sitagliptin is recommended.

Food Interaction

  • Take with or without food.

[Moderate] GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes.

Hypoglycemia most frequently occurs during acute consumption of alcohol.

Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise.

The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia.

Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion.

By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia.

Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes.

A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis.

Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan.

Alcohol should not be consumed on an empty stomach or following exercise.

Sitagliptin Disease Interaction

Major: pancreatitisModerate: renal dysfunction

Volume of Distribution

198L.

Elimination Route

Sitagliptin is 87% orally bioavailable and taking it with or without food does not affect its pharmacokinetics. Sitagliptin reaches maximum plasma concentration in 2 hours.

Half Life

Approximately 12.4 hours. Other studies have reported a half life of approximately 11 hours.

Clearance

350mL/min.

Elimination Route

Approximately 79% of sitagliptin is excreted in the urine as the unchanged parent compound. 87% of the dose is eliminated in the urine and 13% in the feces.

Pregnancy & Breastfeeding use

Pregnancy: Pregnancy Category B. Safety of Sitagliptin in pregnant women has not been established. Sitagliptin should be used during pregnancy only if the potential benefit justifies the potential risk of the fetus.

Nursing Mothers: It is not known whether Sitagliptin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Sitagliptin is administered to a nursing woman.

Contraindication

History of a serious hypersensitivity reaction to Sitagliptin, such as anaphylaxis or angioedema.

Special Warning

Renal Insufficiency-

  • Mild renal insufficiency (creatinine clearance [CrCl] >50 mL/min, approximately corresponding to serum creatinine levels of >1.7 mg/dL in men and >1.5 mg/dL in women), no dosage adjustment for Sitagliptin is required.
  • Moderate renal insufficiency (CrCl >30 to 1.7 to 1.5 to
  • Severe renal insufficiency (CrCl 3.0 mg/dL in men and > 2.5 mg/dL in women) or with end -stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis, the dose of Sitagliptin is 25 mg once daily. Sitagliptin may be administered without regard to the timing of hemodialysis. Concomitant Use with a Sulfonylurea- When Sitagliptin is used in combination with a sulfonylurea, a lower dose of sulfonylurea may be required to reduce the risk of hypoglycemia.

Hepatic Insufficiency: No dosage adjustment is necessary for patients with mild to moderate hepatic insufficiency. Sitagliptin has not been studied in patients with severe hepatic insufficiency.

Acute Overdose

During controlled clinical trials in healthy subjects, single doses of up to 800 mg sitagliptin were administered. Minimal increases in QTc, not considered to be clinically relevant, were observed in one study at a dose of 800 mg sitagliptin. There is no experience with doses above 800 mg in clinical studies. In Phase I multiple-dose studies, there were no dose-related clinical adverse reactions observed with sitagliptin with doses of up to 600 mg per day for periods of up to 10 days and 400 mg per day for periods of up to 28 days.

In the event of an overdose, it is reasonable to employ the usual supportive measures, e.g., remove unabsorbed material from the gastrointestinal tract, employ clinical monitoring (including obtaining an electrocardiogram), and institute supportive therapy if required.

Sitagliptin is modestly dialysable. In clinical studies, approximately 13.5 % of the dose was removed over a 3- to 4-hour hemodialysis session. Prolonged haemodialysis may be considered if clinically appropriate. It is not known if sitagliptin is dialysable by peritoneal dialysis.

Storage Condition

Keep out of the reach of children. Store below 30° C. Keep in the original package in a cool & dry place in order to protect from light and moisture.

Innovators Monograph

You find simplified version here Sitagliptin

Sitagliptin contains Sitagliptin see full prescribing information from innovator Sitagliptin Monograph, Sitagliptin MSDS, Sitagliptin FDA label

FAQ

What is Sitagliptin used for?

Sitagliptin used to treat type 2 diabetes. Type 2 diabetes is an illness where the body does not make enough insulin, or the insulin that it makes does not work properly.

How safe is Sitagliptin?

Sitagliptin may increase your risk of pancreatitis.This can be severe and sometimes fatal. Before you start taking this drug, tell your doctor if you've ever had pancreatitis.

How does Sitagliptin work?

Sitagliptin work by increasing the amount of insulin that your body makes. Insulin is the hormone that controls sugar levels in your blood.

What are the common side effects of Sitagliptin?

Common side effects of Sitagliptin are include:

  • runny or stuffy nose
  • diarrhea
  • headache
  • constipation
  • swelling of extremities
  • nausea
  • sore throat
  • osteoarthritis
  • upper respiratory tract infection
  • hypersensitivity reactions (severe allergic reaction, skin swelling, rash, hives, inflamed blood vessels under the skin, and exfoliative skin conditions [including Stevens-Johnson syndrome])
  • liver enzyme elevations
  • acute pancreatitis
  • constipation
  • vomiting
  • worsening renal function, including acute kidney failure
  • severe and disabling joint pain
  • muscle pain
  • pain in extremities
  • back pain
  • low blood sugar

Is Sitagliptin safe during pregnancy?

Sitagliptin is generally not recommended in pregnancy.

Is Sitagliptin safe during breastfeeding?

Sitagliptin is generally not recommended in  while breastfeeding.

Can I drink alcohol with Sitagliptin?

Yes, you can drink alcohol while taking Sitagliptin. But it's best to drink no more than 2 units per day. Drinking more than this can increase your risk of low blood sugar.

Can I drive after taking Sitagliptin?

Taking Sitagliptin should not affect your ability to drive, cycle or use machinery and tools. If your blood sugar levels become too low, this can reduce your concentration. If this happens to you, do not drive, cycle or use machines or tools until you feel better.

How quickly does Sitagliptin work?

Sitagliptin on your blood sugar levels may begin quickly, within the first 1 to 2 weeks. You may start to see your blood sugar drop after just a few doses.

When should I take Sitagliptin before or after meals?

You can take Sitagliptin before or after a meal. If you have been prescribed a combination tablet of sitagliptin with metformin you should take one tablet twice a day, after meals.

Can I take Sitagliptin long time?

Sitagliptin have to take it for a long time, even for the rest of your life.

What happens if I stop Sitagliptin?

If you don't take it at all, Your symptoms of type 2 diabetes may not improve or may even get worse. If you stop taking it suddenly, If your condition improved while you were taking sitagliptin and then you suddenly stop taking it, your symptoms of type 2 diabetes may come back.

How often do I take Sitagliptin?

You will normally take Sitagliptin once a day as directed by your doctor. You can take it in the morning or evening, but it’s best to try to take it at the same time each day.

What happen if I miss my Sitagliptin?

If you miss a dose, take it as soon as you remember. If it’s time for your next dose, skip the medication and get back on your regular schedule. Don’t double up and take two tablets at the same time, or take one-half of a tablet.

Is Sitagliptin bad for my liver?

Sitagliptin may have a negative effect on the liver for certain patients.

Can I stop taking Sitagliptin?

Do not stop taking Sitagliptin without speaking to your doctor.

Can I take overdose of Sitagliptin?

If you take too much Sitagliptin, call your local Poison Control Center right away.

Can Sitagliptin cause weight loss?

This medicine does not usually make you put on weight.

Can I take Sitagliptin at night?

You can take Sitagliptin in the morning or at night.

*** Taking medicines without doctor's advice can cause long-term problems.
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