Jansitin (Sitagliptin)

Sitagliptin is a DPP‑4 inhibitor indicated for managing type 2 diabetes mellitus and related therapeutic pathways.

• Type 2 diabetes mellitus: lowers blood glucose levels when used with diet and exercise.
• Combination with metformin: provides additional reduction in HbA1c compared with metformin alone.
• Combination with insulin: helps achieve target glycaemic control in patients requiring insulin therapy.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 enzyme, which degrades the incretin hormones GLP‑1 and GIP. By preventing this degradation, circulating levels of GLP‑1 and GIP rise, leading to glucose‑dependent stimulation of insulin secretion and suppression of glucagon release, thereby improving post‑prandial and fasting glucose control.

Sitagliptin is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nasopharyngitis: mild upper respiratory tract infection symptoms.
• Headache: transient mild to moderate headache.
• Upper respiratory infection: cough, sore throat, or congestion.
• Nausea: occasional mild nausea.
• Diarrhoea: loose stools that are usually self‑limiting.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Joint pain: unexplained arthralgia that may be persistent.
• Bullous pemphigoid: rare skin blistering disorder.
• Hepatic injury: elevated liver enzymes or hepatitis.

Before initiating sitagliptin therapy, several safety considerations should be reviewed.

• Renal impairment: assess renal function and adjust dose if necessary.
• Hepatic impairment: monitor liver enzymes and use with caution.
• Hypersensitivity: discontinue if signs of allergic reaction appear.
• Cardiovascular disease: observe for any worsening of heart failure symptoms.
• Pregnancy and lactation: limited data; prescribe only if potential benefit justifies risk.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, and protect from moisture.

Sitagliptin may interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Sulfonylureas: increased risk of hypoglycaemia.
• Insulin: additive glucose‑lowering effect may cause hypoglycaemia.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): raise sitagliptin plasma levels.

Moderate Interactions (Monitor Closely)

• Rifampin: may decrease sitagliptin exposure, reducing efficacy.
• Diuretics: altered renal clearance may affect drug concentration.
• ACE inhibitors: monitor renal function when used together.