Maysiglu (Sitagliptin)

Sitagliptin is used to manage hyperglycaemia in the type 2 diabetes mellitus therapeutic pathway.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose levels.
• Monotherapy: provides glycaemic control when used alone in patients inadequately controlled by diet and exercise.
• Combination therapy: enhances glucose control when added to metformin or other antidiabetic agents.

• 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 endogenous incretin levels, leading to glucose‑dependent stimulation of insulin secretion and suppression of glucagon release, thereby reducing plasma glucose concentrations.

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

Common Side Effects

• Nasopharyngitis: mild inflammation of the nasal passages and throat.
• Headache: transient mild to moderate pain.
• Upper respiratory tract infection: symptoms such as cough and sore throat.
• Gastrointestinal upset: includes nausea, diarrhoea, or abdominal discomfort.
• Dizziness: occasional light‑headedness.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: including rash, angioedema, or anaphylaxis.
• Bullous pemphigoid: rare skin blistering condition.
• Hepatic injury: signs of liver dysfunction such as jaundice.
• Hypersensitivity reactions: including fever, eosinophilia, or organ involvement.

Before initiating therapy with sitagliptin, consider the following precautions.

• Renal function: dose adjustment may be required in patients with impaired renal clearance.
• Hepatic impairment: monitor liver enzymes in patients with existing liver disease.
• Concomitant sulfonylureas or insulin: increased risk of hypoglycaemia; monitor blood glucose closely.
• History of pancreatitis: avoid use or discontinue promptly if symptoms recur.
• Elderly patients: start at the lowest effective dose and monitor for adverse effects.
• Store at ambient temperature: keep below 25 °C, retain in the original container, and protect from moisture.

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

Major Interactions (Avoid)

• Other DPP‑4 inhibitors: concurrent use can lead to excessive DPP‑4 inhibition and increased adverse events.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may raise sitagliptin plasma levels.

Moderate Interactions (Monitor Closely)

• Insulin or sulfonylureas: heightened risk of hypoglycaemia; adjust dose as needed.
• Rifampin: induces metabolism and may reduce sitagliptin exposure.
• Ketoconazole: can increase sitagliptin concentrations; monitor for side effects.
• Diuretics (e.g., furosemide): may affect renal clearance; observe renal function.