Janeo (Sitagliptin)

Sitagliptin is indicated for the management of type 2 diabetes mellitus, a chronic metabolic disorder affecting glucose regulation.

• Type 2 diabetes mellitus: improves glycemic control when combined with diet and exercise.
• As monotherapy: lowers HbA1c levels in patients inadequately controlled by lifestyle alone.
• As add‑on therapy: enhances glucose control when used with other antidiabetic agents such as metformin or sulfonylureas.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the breakdown of endogenous incretin hormones (GLP‑1 and GIP). Elevated incretin levels increase glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, resulting in reduced post‑prandial glucose excursions and overall improved glycemic control.

Sitagliptin is generally well tolerated, but several adverse reactions have been reported.

Common Side Effects

• Nasopharyngitis: mild upper‑respiratory tract infection symptoms.
• Headache: transient mild to moderate pain.
• Upper respiratory infection: cough, sore throat, or congestion.
• Gastrointestinal upset: nausea, abdominal discomfort, or diarrhea.
• Dizziness: occasional light‑headed sensation.
• Arthralgia: joint pain without swelling.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain with vomiting.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Bullous skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatic injury: elevated liver enzymes or jaundice.
• Severe hypoglycemia: especially when combined with insulin or sulfonylureas.
• Renal impairment worsening: increased serum creatinine or reduced clearance.

Before initiating therapy, clinicians should consider several safety aspects.

• Renal function assessment: adjust dose in patients with reduced creatinine clearance.
• Pancreatitis monitoring: educate patients to report persistent abdominal pain.
• Concomitant hypoglycemic agents: monitor for additive glucose‑lowering effect.
• Elderly patients: start at lower dose and observe tolerance.
• Hepatic impairment: use with caution and evaluate liver enzymes.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Sitagliptin may interact with other medicines, requiring attention to dosage and monitoring.

Major Interactions (Avoid)

• Insulin or sulfonylureas: increased risk of hypoglycemia.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may raise sitagliptin plasma levels.
• Other DPP‑4 inhibitors: combined use offers no added benefit and raises adverse‑event risk.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may affect renal clearance of sitagliptin.
• Rifampin: may reduce sitagliptin exposure, requiring efficacy monitoring.