Mapoli (Sitagliptin)

Mapoli (sitagliptin) is used within the antidiabetic therapeutic pathway to manage hyperglycaemia in type 2 diabetes.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose levels.
• Combination therapy with metformin: provides additive glycaemic control when monotherapy is insufficient.
• Adjunct to diet and exercise: supports overall diabetes management alongside lifestyle measures.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the breakdown of endogenous incretin hormones (GLP‑1 and GIP). Elevated incretin levels enhance glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, resulting in improved post‑prandial glucose regulation without causing hypoglycaemia in the absence of other secretagogues.

Adverse reactions may occur with sitagliptin therapy.

Common Side Effects

• Nasopharyngitis: mild upper‑respiratory tract infection symptoms.
• Headache: transient cranial discomfort.
• Gastrointestinal upset: nausea, diarrhoea or abdominal pain.
• Dizziness: occasional light‑headed sensation.
• Upper respiratory infection: cough or sore throat.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angio‑edema or anaphylaxis.
• Joint pain: unexplained arthralgia that may be persistent.
• Bullous pemphigoid: rare blistering skin disorder.
• Hepatic injury: abnormal liver function tests or hepatitis.

Before initiating sitagliptin, consider the following safety measures.

• Renal impairment: dose adjustment may be required based on creatinine clearance.
• Hepatic impairment: monitor liver enzymes in patients with existing liver disease.
• Cardiovascular disease: use cautiously in patients with a history of heart failure.
• Elderly patients: start at the lowest effective dose and monitor for adverse events.
• Pregnancy and breastfeeding: safety not established; avoid unless benefits outweigh risks.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): increase sitagliptin exposure.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): raise plasma concentrations.
• Sulfonylureas or insulin secretagogues: heightened risk of hypoglycaemia.

Moderate Interactions (Monitor Closely)

• Thiazide diuretics: may affect glucose homeostasis.
• ACE inhibitors or ARBs: monitor renal function and potassium.
• NSAIDs: potential additive renal stress, especially in compromised patients.