Maysiglu (Sitagliptin)

Sitagliptin is used to manage type 2 diabetes mellitus, a chronic metabolic disorder affecting glucose regulation.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose levels.
• As monotherapy when diet and exercise alone are insufficient: provides additional glycaemic control.
• In combination with metformin: enhances overall glucose‑lowering effect.
• As part of fixed‑dose combinations with other oral agents: simplifies regimen while maintaining efficacy.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the breakdown of endogenous incretin hormones such as GLP‑1 and GIP. Elevated incretin levels increase glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, resulting in reduced hepatic glucose production and improved post‑prandial glucose control.

Sitagliptin is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient cranial discomfort.
• Nasopharyngitis: upper respiratory tract inflammation.
• Upper respiratory infection: symptoms of cold or flu.
• Dizziness: occasional light‑headedness.
• Diarrhoea: loose stools, usually self‑limiting.

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 chronic.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Bullous pemphigoid: blistering skin disorder.
• Hypoglycaemia (when combined with insulin or sulfonylureas): low blood sugar episodes.

Before initiating sitagliptin therapy, several safety considerations should be reviewed.

• Renal function: assess creatinine clearance and adjust dose if necessary.
• History of pancreatitis: monitor for recurrent abdominal pain.
• Hypersensitivity: discontinue if signs of allergic reaction appear.
• Elderly patients: start at lower dose and monitor for adverse events.
• Hepatic impairment: evaluate liver function and consider dose modification.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Insulin: increased risk of hypoglycaemia.
• Sulfonylureas (e.g., glipizide): heightened hypoglycaemic potential.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may raise sitagliptin plasma levels.
• Strong CYP2C8 inducers (e.g., rifampin): may reduce sitagliptin exposure.

Moderate Interactions (Monitor Closely)

• Warfarin: monitor INR for possible anticoagulant effect changes.
• Digoxin: observe for altered serum concentrations.
• Diuretics: watch renal function and electrolyte balance.
• NSAIDs: assess renal function, especially in patients with pre‑existing kidney disease.