Juzina (Sitagliptin Hydrochloride Monohydrate)

Sitagliptin is indicated for the management of type 2 diabetes, acting on the incretin pathway to regulate blood glucose.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial glucose levels when used alone or with other antidiabetic agents.
• Combination therapy with metformin: provides additional HbA1c reduction compared with metformin monotherapy.
• Adjunct to diet and exercise: helps patients achieve glycaemic targets when lifestyle measures are insufficient.

• Sitagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones GLP‑1 and GIP. By preventing this degradation, sitagliptin increases circulating levels of GLP‑1 and GIP, enhancing glucose‑dependent insulin secretion and suppressing glucagon release, thereby improving post‑prandial and overall glycaemic 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 pain.
• Upper respiratory tract infection: cough, sore throat.
• Gastrointestinal upset: nausea, abdominal discomfort.
• Dizziness: occasional light‑headedness.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Joint pain: unexplained arthralgia, sometimes persistent.
• Bullous pemphigoid: rare skin blistering disorder.
• Hypoglycaemia: particularly when combined with insulin or sulfonylureas.

Before initiating sitagliptin therapy, consider the following safety points.

• Renal impairment: dose adjustment may be required; monitor renal function.
• Hepatic impairment: use with caution in patients with moderate liver disease.
• Cardiovascular disease: assess risk, especially in patients with a history of heart failure.
• Pregnancy: category B; discuss potential benefits and risks with a healthcare professional.
• Elderly patients: start at the lowest effective dose and monitor for adverse events.
• Store at ambient temperature: keep below 25 °C, protect from moisture, and retain in the original packaging.

Sitagliptin may interact with other medicines, influencing efficacy or safety.

Major Interactions (Avoid)

• Concomitant insulin therapy: increased risk of hypoglycaemia.
• Sulfonylureas (e.g., glipizide): heightened hypoglycaemia potential.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may affect renal clearance of sitagliptin.
• ACE inhibitors (e.g., enalapril): monitor blood pressure and renal function.
• Rifampin: enzyme induction may reduce sitagliptin plasma levels.
• NSAIDs (e.g., ibuprofen): watch for renal function changes in susceptible patients.