Juzina (Sitagliptin Hydrochloride Monohydrate)

Sitagliptin is a DPP‑4 inhibitor used to improve glycemic control in type 2 diabetes.

• Type 2 diabetes mellitus (monotherapy): lowers fasting and post‑prandial blood glucose when added to diet and exercise.
• Type 2 diabetes mellitus (combined with metformin): provides additional glucose reduction in patients inadequately controlled on metformin alone.
• Type 2 diabetes mellitus (combined with insulin or sulfonylureas): enhances overall glycemic control while allowing lower doses of insulin or sulfonylureas.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the rapid degradation of the incretin hormones glucagon‑like peptide‑1 (GLP‑1) and glucose‑dependent insulinotropic polypeptide (GIP). Elevated levels of these hormones enhance glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, resulting in improved post‑prandial and fasting glucose regulation without causing hypoglycaemia in the absence of other glucose‑lowering agents.

Sitagliptin may cause a range of adverse reactions, which are categorized by frequency.

Common Side Effects

• Nasopharyngitis: mild inflammation of the nose and throat.
• Headache: transient head pain.
• Upper respiratory tract infection: symptoms such as cough and congestion.
• Nausea: feeling of stomach upset.
• Diarrhoea: loose stools.
• Abdominal pain: discomfort in the stomach area.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain possibly indicating pancreatic inflammation.
• Severe allergic reactions: rash, swelling, or difficulty breathing.
• Joint pain: unexplained arthralgia.
• Elevated liver enzymes: signs of hepatic stress.
• Bullous pemphigoid: rare skin blistering disorder.
• Hypoglycaemia (when combined with insulin or sulfonylureas): low blood sugar episodes.

Before prescribing Juzina, clinicians should consider several precautionary measures.

• Renal impairment: assess kidney function and adjust dose or avoid in severe cases.
• Hepatic impairment: use with caution in patients with liver disease.
• History of pancreatitis: avoid use due to risk of recurrence.
• Concomitant insulin or sulfonylureas: monitor for hypoglycaemia and adjust doses.
• Pregnancy and breastfeeding: safety not established; prescribe only if benefits outweigh risks.
• Store at ambient temperature: keep below 25 °C in the original packaging, protected from moisture.

Sitagliptin can interact with other medicines, requiring attention to the interaction level.

Major Interactions (Avoid)

• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may increase sitagliptin exposure and risk of adverse effects.
• Combined use with insulin or sulfonylureas: can cause severe hypoglycaemia.

Moderate Interactions (Monitor Closely)

• Rifampin: may reduce sitagliptin plasma concentrations, decreasing efficacy.
• Diuretics (e.g., thiazides): may affect glucose control, requiring monitoring.
• Warfarin: potential alteration of INR, necessitating regular coagulation checks.