Juzina (Sitagliptin)

• Sitagliptin is indicated for glycaemic management in the type 2 diabetes mellitus therapeutic pathway.
• Type 2 diabetes mellitus: improves glycaemic control as part of oral antidiabetic therapy, alone or in combination with other agents.

• Sitagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones GLP‑1 and GIP. By blocking DPP‑4, sitagliptin raises endogenous incretin levels, enhancing glucose‑dependent insulin secretion from pancreatic β‑cells and reducing glucagon release from α‑cells, thereby lowering both post‑prandial and fasting plasma glucose concentrations.

Sitagliptin may be associated with a range of adverse reactions, which are categorised by frequency and severity.

Common Side Effects

• Nasopharyngitis: mild inflammation of the nose and throat.
• Headache: transient cranial pain.
• Upper respiratory tract infection: cough, sore throat, or congestion.
• Nausea: occasional feeling of stomach upset.
• Diarrhoea: loose stools.
• Abdominal pain: mild discomfort in the stomach area.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain with elevated enzymes.
• Severe allergic reactions: including angioedema, anaphylaxis, or Stevens‑Johnson syndrome.
• Joint pain: acute, severe arthralgia.
• Hepatic injury: marked elevation of liver enzymes.
• Hypersensitivity reactions: rash, fever, eosinophilia.
• Bullous pemphigoid: rare blistering skin disorder.

When prescribing sitagliptin, clinicians should consider several precautionary measures to ensure safe use.

• Renal function: assess baseline kidney function and adjust dose in moderate to severe impairment.
• Pancreatitis history: evaluate for prior episodes and discontinue if symptoms develop.
• Hypersensitivity: monitor for signs of allergic reaction, especially skin rash or swelling.
• Elderly patients: use with caution due to potential comorbidities and polypharmacy.
• Concomitant medications: review for drugs that may affect glucose levels or renal clearance.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Insulin or sulfonylureas: combined use may increase risk of hypoglycaemia; dose adjustments are required.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): can raise sitagliptin plasma concentrations, increasing adverse effect risk.

Moderate Interactions (Monitor Closely)

• Rifampin: induces metabolism and may reduce sitagliptin exposure, potentially diminishing glucose‑lowering effect.
• Diuretics: may affect glycaemic control; monitor blood glucose.
• ACE inhibitors or ARBs: observe renal function and potassium levels when used together.
• Anticoagulants: monitor INR as glycaemic changes can influence anticoagulation.