BMA Concise Guide to Medicine & Drugs

Sitagliptin

Brand name Januvia

Used in the following combined preparation Janumet (with metformin)

QUICK REFERENCE

Drug group Drug for diabetes

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Sitagliptin is used to treat Type 2 diabetes in combination with diet, exercise, weight control, and often other antidiabetic drugs. It is one of a new class of oral antidiabetic drugs, known as DPP-4 inhibitors or gliptins, which block the breakdown of hormones called incretins. Incretins help to increase insulin production, but only when it is needed, such as after a meal. Gliptins increase the incretin level after a meal, resulting in an increased insulin level, which helps to prevent a blood sugar “high” after eating.

Gliptins are less likely to cause abnormally low blood sugar levels (hypoglycaemia) than other antidiabetic drugs if used on their own. Unlike the sulphonylureas, gliptins do not cause weight gain. Sitagliptin can be used alone or in combination with other antidiabetic drugs, such as metformin or insulin.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily; can be taken with or without food.

Adult dosage range 100mg daily.

Onset of effect Within 1 hour.

Duration of action Up to 24 hours.

Diet advice An individualized diabetic diet must be maintained for the drug to be fully effective. Follow the advice of your doctor.

Storage Store at room temperature away from moisture, heat, and light and out of the reach of children.

Missed dose Take as soon as you remember. Do not take a double dose on the same day.

Stopping the drug Do not stop taking the drug without consulting your doctor; stopping the drug may lead to worsening of your diabetes control.

OVERDOSE ACTION

Seek immediate medical attention. If you have early warning signs of low blood sugar (such as faintness, dizziness, headache, confusion, sweating, or tremor), eat or drink something sugary. Take emergency action if seizures or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Serious side effects are rare with sitagliptin. The most common are stomach discomfort and diarrhoea. Less commonly, it may cause symptoms of hypoglycaemia (low blood sugar), such as headache, sweating, weakness, tremor, dizziness, faintness, confusion; these are more likely to occur when sitagliptin is used in combination with other antidiabetic drugs. If they do occur, eat or drink something sugary and seek immediate medical help. If you develop a severe rash or skin blistering, you should stop taking the drug and consult your doctor promptly. If you have severe abdominal pain or vomiting, you should stop taking the drug and contact your doctor immediately.

INTERACTIONS

General note Many drugs may interact with sitagliptin to affect blood sugar levels. Some medicines contain sugar and may upset diabetic control. Consult your doctor or pharmacist before taking any other medicines.

Beta blockers may mask symptoms of low blood sugar when taken with sitagliptin.

Digoxin Sitagliptin may increase the blood level of digoxin.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term kidney problems.

· You have a history of pancreatitis.

· You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Present in breast milk. Safety not established. Discuss with your doctor.

Infants and children Not prescribed.

Over 60 No special problems.

Driving and hazardous work Avoid such activities if you have warning signs of low blood sugar.

Alcohol Avoid. Alcohol may upset diabetic control.

Surgery and general anaesthetics Notify your doctor or dentist that you have diabetes. Your diabetes medication may need to be altered, and sometimes insulin may need to be substituted.

PROLONGED USE

There is a small increased risk of upper respiratory tract and urinary infections when taking sitagliptin long-term.

Monitoring Regular monitoring of your diabetes control is necessary. You may also have periodic assessment of the eyes, heart, and kidneys.