Why sitagliptin

Sitagliptin belongs to a class of drugs called dipeptidyl peptidase-4 DPP-4 inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Insulin is a chemical in your body that helps remove sugar from your blood and moves it to cells, where it can be used for energy. Hormones in your body called incretins regulate the production and release of insulin.

This helps your body use insulin better and lowers your blood sugar. If these effects are mild, they may go away within a few days or a couple of weeks. Call your doctor right away if you have serious side effects. Serious side effects and their symptoms can include the following:. Sitagliptin will decrease your blood sugar levels.

It could cause hypoglycemia, which is when your blood sugar level drops too low. If this happens, you need to treat it. You need to eat or drink one of the following:. Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, then repeat the above treatment. Once your blood sugar level is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help prevent interactions, your doctor should manage all of your medications carefully. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions.

Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking. When you take sitagliptin with certain other diabetes drugs, your blood sugar can drop too low. Examples of these drugs include:. Taking it again could be fatal cause death.

For people with pancreatitis: Sitagliptin may increase your risk of pancreatitis. If you have pancreatitis already, your doctor may choose another medication to treat your diabetes. For people with kidney problems: Your dosage of this drug will depend on your kidney function. Sitagliptin should be used during pregnancy only if the potential benefit justifies the potential risk. If you do use this drug during pregnancy, talk to your doctor about taking part in the Pregnancy Registry for this drug.

It tracks the effects of using sitagliptin in pregnant women. For seniors: As you age, your kidneys may not work as well as they did when you were younger. This medicine is not used to treat type 1 diabetes when your body does not produce insulin. You can take it at any time - for example, in the morning or in the evening. Just try to take it at the same time every day.

Take your tablet with a glass of water. Swallow the tablet whole, without breaking it. Your doctor might give you a lower dose of 25mg or 50mg a day if you have problems with your kidneys. Take the missed dose as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time. You could ask your pharmacist for advice on other ways to remember your medicines.

The most common side effects, which happen in more than 1 in people, are headaches. If taking sitagliptin gives you a headache, make sure you rest and drink plenty of fluids. Do not drink too much alcohol.

It happens rarely, but some people may have serious side effects after taking sitagliptin. Sitagliptin does not usually cause low blood sugar known as hypoglycaemia, or "hypos" when taken on its own. But hypos can happen when you take sitagliptin with other diabetes medicines, such as insulin or gliclazide. It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up. It's important to have regular meals, including breakfast, to prevent hypoglycaemia.

Never miss or delay a meal. If you're planning to exercise more than usual, make sure you eat carbohydrates like bread, pasta or cereals before, during or after exercise. Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low.

Artificial sweeteners will not help. You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

If taking in sugar does not help or the hypo symptoms come back, contact your doctor or the nearest hospital. Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens. It's possible to have a serious allergic reaction anaphylaxis to sitagliptin.

You could be having a serious allergic reaction and may need immediate treatment in hospital. You can report any suspected side effect to the UK safety scheme.

Sitagliptin is generally not recommended in pregnancy or while breastfeeding. Talk to your doctor, as there may be other medicines you can take instead of sitagliptin.

Make sure that your doctor and pharmacist know you're taking sitagliptin before starting or stopping any other medicine. There's very little information about taking herbal remedies and supplements with sitagliptin.

For safety, tell your doctor and pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements. Sitagliptin belongs to a group of medicines called dipeptidylpeptidase-4 inhibitors DPP-4 inhibitors or gliptins. It's used to treat type 2 diabetes , which is caused by problems with a hormone in your body called insulin. Gliptins help your body make more insulin.

They also stop your body releasing too much sugar glucose into your blood. You need to take it every day to make sure your blood sugar stays as stable as possible.

Sitagliptin helps keep your blood sugar level as normal as possible to prevent health problems. You'll probably have to take it for a long time, even for the rest of your life. Over time it gets harder to control blood sugar levels, so your doctor might eventually recommend stopping sitagliptin and trying a different treatment.

If you're taking other medicines for diabetes, your doctor may recommend reducing the dose of your other medicines when you start sitagliptin. Sitagliptin is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or even years. You may have seen news stories linking sitagliptin with pancreatic cancer.

But there's no firm evidence that sitagliptin causes cancer. Similar medicines include alogliptin, linagliptin, saxagliptin and vildagliptin. There are other diabetes medicines that you swallow, such as metformin, gliclazide, glimepiride, pioglitazone, canagliflozin, dapagliflozin and empagliflozin. Your doctor might recommend taking more than one type of diabetes medicine at the same time. If you have diabetes , you're entitled to free prescriptions for all of your medicines, not just your diabetes ones.

In addition, the proportion of patients who achieved the recommended glycemic target increased by twofold 7—12 months after the patient was on sitagliptin. After sitagliptin was initiated for 7—12 months, the number of patients who achieved HbA 1c below 6.

The incidence of hypoglycemia reduced significantly from 61 patients Prior to the initiation of sitagliptin, the mean weight SD of patients was However, 12 months after the initiation of sitagliptin, the mean weight SD decreased to Sitagliptin was associated with side effects in eleven patients.

Three patients had hypoglycaemia, whereas each of the remaining patients had worsening of allergic reaction, cough, weight loss, drowsiness, increase in creatinine level, swelling of the leg, and bloating and one patient just could not tolerate sitagliptin with no specific reason given.

Sitagliptin is a DPP-4 inhibitor which is a relatively new group of antidiabetes medications in the market. Despite the lack of data on its effectiveness in clinical practice, its use has escalated since its introduction over the past few years.

The number of patients prescribed with sitagliptin in the present study has doubled from to Most of the patients on sitagliptin were 65 years old and above. This could be due to its potential benefits for causing minimal or no hypoglycemia in comparison to other antidiabetes medications such as the sulphonylureas [ 18 , 19 ]. In addition, it is also more convenient due to its once daily oral dosing [ 18 , 22 ].

A majority of the patients prescribed with sitagliptin were overweight based on their BMI or waist circumference as defined by the clinical practice guidelines [ 20 ].

Sitagliptin is preferred for overweight patients as it is weight neutral [ 12 , 13 , 17 , 18 ]. This is an advantage over other antidiabetes medications such as the thiazolidinediones and sulphonylureas which are often associated with weight gain [ 18 , 23 ].

However, this study did not demonstrate any significant change in body weight after the initiation of sitagliptin. The mean SD duration of diabetes of patients prescribed with sitagliptin was This is similar to a study conducted in Taiwan although other studies had shown a shorter duration of 2 to 6 years [ 14 , 17 , 18 ].

Patients with a shorter duration of diabetes showed greater reduction in HbA 1c with the addition of sitagliptin; hence sitagliptin should be started earlier for better effect [ 18 ].

Sitagliptin was added to the existing antidiabetes regimens of most patients due to uncontrolled diabetes. This is consistent with that of other studies [ 9 , 14 , 24 , 25 ].

This also accounts for the high baseline HbA 1c values in a majority of the patients Sitagliptin was usually prescribed for patients who were already on metformin and sulphonylurea. This means that sitagliptin was only initiated when the older groups of antidiabetes medications failed to produce adequate glycemic control. This is because sitagliptin is a relatively new antidiabetes agent and hence is reserved as an add-on therapy for patients who are unable to tolerate other antidiabetes medications or who have not reached the glycemic target with the standard first-line agents [ 8 ].

In the present study, 6. Sitagliptin is generally well tolerated with minimal adverse effects [ 14 , 24 ]. This is a potential benefit of DPP-4 inhibitors as the occurrence of adverse effects often led to nonadherence to antidiabetes medications which in turn contributes to poor glycemic control [ 14 ]. It has been reported that patients on sitagliptin were less likely to discontinue their medications due to adverse reactions as compared to metformin monotherapy [ 26 ].

Studies have shown that sitagliptin reduced HbA 1c by 0. However, the GEE model predicted a greater HbA 1c reduction 3 to 6 months after initiation of sitagliptin which is 0.

This increment in HbA 1c may not be seen in studies which only had two-point measurements of HbA 1c at baseline and at the end of the study. However, studies with more than two-point measurements showed similar effects with the use of sitagliptin [ 18 , 27 ]. A study in Japan which reported similar outcomes attributed this increase to a reduction in compliance with diet and exercise therapy [ 28 ].

In addition, twice as many patients managed to attain glycemic control after the initiation of sitagliptin for 7 to 12 months. Other clinical studies showed similar results although they were carried out specifically to compare the efficacy of sitagliptin with placebo [ 12 , 18 ]. One recent retrospective study which also assessed the effectiveness of sitagliptin in a clinical practice reported similar increase in the proportion of patients achieving glycemic control after using sitagliptin although the average reduction in HbA 1c is higher than that of the present study [ 29 ].

Mafauzy reported that On the contrary, The difference may be attributed to the advance in technology from to and hence more patients have access to more convenient and cheaper glucose meters. The increase in the use of home glucose meters may also be due to an increase in awareness on the importance of self-monitoring of blood glucose. There are several limitations in this study. Some data were not available as only information written in the patient medical records could be extracted.

In the present study, a change in medications during and after the initiation of sitagliptin may occur but this was taken into account during the GEE model analysis which showed that changes in patients' medications did not significantly affect the change in HbA 1c levels. Patients' adherence to their medications could not be ascertained as no adherence assessment was carried out. Dietary habit and exercise could not be controlled, which may have affected the change in HbA 1c.

In conclusion, the study provides evidence that sitagliptin produces a significant reduction of 0. However, this reduction in HbA 1c was lesser 7 to 12 month later 0. Further investigations are required to determine if reduced adherence to sitagliptin is the reason for the increase in HbA 1c with prolonged usage of sitagliptin.

The authors would like to express their gratitude to the following persons who contributed to this study in one way or another: Mr. Samihah binti Mat Junoh University of Malaya.

The content of this paper was presented as a poster at the Malaysian Diabetes Educators Society Conference which was held in Malaysia on April 25 to 27, The authors declare that there is no conflict of interests regarding the publication of this paper. National Center for Biotechnology Information , U. Journal List Int J Endocrinol v. Int J Endocrinol. Published online May Author information Article notes Copyright and License information Disclaimer.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Aim.

Introduction The prevalence of diabetes is increasing worldwide. Materials and Methods 2. Patients and Setting A retrospective study was conducted in a major teaching hospital in Kuala Lumpur, Malaysia. Data Collection A list of sitagliptin transactions in the teaching hospital was retrieved from its PIS. Results 3. Demographic and Baseline Characteristics of Patients A total of patients were prescribed with sitagliptin at the major teaching hospital in Malaysia from to Open in a separate window.

Figure 1. Table 1 Baseline demographic and clinical characteristics of patients. SD: standard deviation. Effectiveness of Sitagliptin Effectiveness of sitagliptin was analyzed based on patients whose HbA 1c levels could be obtained for all the three points before initiation of sitagliptin, 3 to 6 months and 7 to 12 months after initiation of sitagliptin.

Figure 2. Parameter B Std. Intercept 1. Dependent variable: HbA 1c. Safety of Sitagliptin The incidence of hypoglycemia reduced significantly from 61 patients Discussion Sitagliptin is a DPP-4 inhibitor which is a relatively new group of antidiabetes medications in the market.