Meliglix (Sitagliptin)

Meliglix (sitagliptin) is used within the antidiabetic therapeutic pathway to lower blood glucose levels in type 2 diabetes mellitus.

• Monotherapy: improves glycaemic control when used alone in adults with type 2 diabetes.
• Combination therapy: enhances glucose lowering when added to metformin or other oral antidiabetics.
• Adjunct therapy: supports glycaemic management together with diet, exercise and lifestyle modifications.

• Sitagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, which results in prolonged activity of incretin hormones (GLP‑1 and GIP). The increased incretin levels enhance glucose‑dependent insulin secretion and suppress glucagon release, thereby lowering post‑prandial and fasting plasma glucose concentrations without causing hypoglycaemia when used alone.

Meliglix is generally well tolerated, but a range of adverse reactions have been reported.

Common Side Effects

• Nausea: mild to moderate upset stomach.
• Headache: transient cranial discomfort.
• Nasopharyngitis: common cold‑like symptoms.
• Upper respiratory tract infection: mild cough or sore throat.
• 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 persistent.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Severe hypoglycaemia: when combined with insulin or sulfonylureas.

Before initiating Meliglix, clinicians should evaluate several safety considerations.

• Renal function: assess creatinine clearance and adjust dose if necessary.
• Hepatic function: monitor liver enzymes in patients with existing liver disease.
• Hypersensitivity: discontinue immediately if signs of allergic reaction appear.
• Pregnancy: use only if potential benefit justifies the risk to the fetus.
• Elderly patients: consider lower starting dose due to possible renal decline.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Meliglix may interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase sitagliptin exposure.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce therapeutic effect.

Moderate Interactions (Monitor Closely)

• Insulin or sulfonylureas: heightened risk of hypoglycaemia, monitor glucose levels.
• Diuretics (e.g., thiazides): may affect renal clearance of sitagliptin.
• Digoxin: slight increase in serum concentrations, observe for toxicity.
• Warfarin: monitor INR as occasional alterations have been reported.