Jidinum (Sitagliptin)

Sitagliptin is used in the management of type 2 diabetes mellitus, a chronic metabolic disorder that requires long‑term glucose control.

• Type 2 diabetes mellitus: improves fasting and post‑prandial blood glucose levels.
• Adjunct to diet and exercise: helps patients reach target HbA1c when lifestyle measures alone are insufficient.
• Combination therapy: can be combined with metformin, sulfonylureas or insulin to enhance overall glycaemic control.

• 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 lowered blood glucose concentrations without causing hypoglycaemia in the absence of other agents.

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

Common Side Effects

• Nasopharyngitis: mild inflammation of the nasal passages and throat.
• Headache: transient, mild to moderate intensity.
• Upper respiratory tract infection: symptoms of cough, sore throat, or congestion.
• Nausea: occasional mild stomach upset.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain that may require immediate medical attention.
• Severe hypersensitivity reactions: including rash, angioedema, or anaphylaxis.
• Bullous pemphigoid: a rare autoimmune blistering skin disorder.

Before initiating sitagliptin therapy, clinicians should consider several safety aspects.

• Renal function: assess creatinine clearance and adjust dose in moderate to severe impairment.
• Pancreatitis history: monitor for abdominal pain and discontinue if pancreatitis is suspected.
• Concomitant hypoglycaemic agents: evaluate risk of additive hypoglycaemia, especially with insulin or sulfonylureas.
• Elderly patients: start at the lowest effective dose and monitor tolerability.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Sitagliptin may interact with other medicines, requiring clinical attention.

Major Interactions (Avoid)

• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may increase sitagliptin plasma concentrations.
• Co‑administration with insulin: heightened risk of hypoglycaemia.

Moderate Interactions (Monitor Closely)

• Sulfonylureas (e.g., glipizide): may potentiate hypoglycaemic effect.
• Diuretics (e.g., thiazides): can affect glucose homeostasis, requiring closer monitoring.
• Rifampin: may reduce sitagliptin exposure, potentially diminishing efficacy.