Does not cause hypoglycaemia. There is a concern that gliptins can cause acute pancreatitis
- Sitagliptin (Januvia) (DPP-4 Inhibitor)
- Check BNF or equivalent for UpToDate prescribing advice
- Does not cause hypoglycaemia
Mode of action
- Inhibits dipeptidylpeptidase-4 to increase Insulin secretion and lower glucagon secretion.
- T2DM as monotherapy (if metformin inappropriate), or with other antidiabetic drugs (including Insulin) if existing treatment fails to achieve adequate glycaemic control.
- Dose: Sitagliptin 100 mg OD Elderly Dose 50 mg OD
- DPP4-inhibitors usually have no effect on weight, and do not cause hypoglycaemia.
- The dose of concomitant sulfonylurea or insulin may need to be reduced to reduce the risk of hypoglycaemia, when used in combination with a gliptin.
- Alogliptin is recommended for first line use, except in patients with renal impairment, when linagliptin is recommended.
- Reduce dose in renal failure
- Reduce dose to 50 mg once eGFR 30-45
- Reduce dose to 25 mg once daily if eGFR < 30
- Discontinue if symptoms of acute pancreatitis occur such as persistent, severe abdominal pain.