Juzina (Sitagliptin)

Sitagliptin is used in the management of type 2 diabetes mellitus, a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion.

• Type 2 diabetes mellitus: improves glycemic control as monotherapy when diet and exercise are insufficient.
• Combination therapy with metformin: provides additional glucose‑lowering effect in patients not achieving target HbA1c.
• Adjunct to lifestyle modification: supports diet and exercise measures to maintain stable blood glucose levels.

• Sitagliptin reversibly inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, which degrades the incretin hormones glucagon‑like peptide‑1 (GLP‑1) and glucose‑dependent insulinotropic polypeptide (GIP). By preventing this degradation, sitagliptin increases circulating levels of GLP‑1 and GIP, enhancing glucose‑dependent insulin secretion and suppressing glucagon release, thereby lowering post‑prandial and fasting plasma glucose concentrations.

Sitagliptin may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Nausea: mild stomach upset that usually resolves without intervention.
• Headache: occasional tension‑type headache.
• Nasopharyngitis: symptoms of a common cold.
• Upper respiratory tract infection: mild cough or sore throat.
• Dizziness: transient light‑headedness.
• Diarrhoea: loose stools that are typically self‑limiting.

Serious or Rare Side Effects

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

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

• Renal function: assess creatinine clearance and adjust dose if necessary.
• Pancreatitis history: monitor for abdominal pain and elevated enzymes.
• Elderly patients: start at the lowest effective dose and monitor tolerability.
• Hypersensitivity: avoid in individuals with known allergy to sitagliptin or excipients.
• Hepatic impairment: use with caution and monitor liver function tests.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Sitagliptin can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Concomitant insulin: increased risk of hypoglycaemia.
• Sulfonylureas (e.g., glipizide): may potentiate hypoglycaemic events.
• Rifampin: reduces sitagliptin plasma concentrations, diminishing effect.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: may enhance hypotensive effects.
• Diuretics: possible impact on glucose control.
• Warfarin: monitor INR as sitagliptin may affect anticoagulation stability.