Meliglix (Sitagliptin)

Sitagliptin is a DPP-4 inhibitor used to manage hyperglycemia in type 2 diabetes.

• Type 2 diabetes mellitus (monotherapy): reduces fasting and post‑prandial glucose levels as a single agent.
• Type 2 diabetes mellitus (combined with metformin): enhances overall glycemic control when added to metformin therapy.
• Type 2 diabetes mellitus (combined with insulin): may allow reduction of insulin dose while maintaining target glucose levels.

• 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 and suppress glucagon release, leading to improved post‑prandial and fasting blood glucose regulation without causing hypoglycemia when used alone.

Adverse reactions reported with sitagliptin vary in frequency and severity.

Common Side Effects

• Nasopharyngitis: mild upper respiratory tract infection symptoms.
• Headache: transient mild to moderate headache.
• Upper respiratory infection: cough, sore throat, or congestion.
• Nausea: occasional mild nausea.
• Diarrhea: loose stools that are usually self‑limiting.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Arthralgia: persistent joint pain.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Hypoglycemia: when combined with insulin or insulin secretagogues.

Before initiating therapy, clinicians should consider several safety factors.

• Renal function assessment: dose adjustment may be required in impaired renal function.
• Monitor for pancreatitis: discontinue if signs of acute pancreatitis appear.
• Use caution in elderly patients: increased susceptibility to adverse events.
• Avoid in patients with known hypersensitivity to sitagliptin or other DPP‑4 inhibitors.
• Assess hepatic function: monitor liver enzymes periodically.
• Store at ambient temperature: keep below 25 °C in the original packaging, protected from moisture and direct sunlight.

Sitagliptin may interact with other medicines, requiring attention to potential effects.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase sitagliptin exposure.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): can raise plasma concentrations.
• Insulin secretagogues (e.g., sulfonylureas): heightened risk of hypoglycemia.

Moderate Interactions (Monitor Closely)

• Diuretics: possible alterations in glucose control.
• ACE inhibitors: monitor renal function and electrolytes.
• Rifampin: may reduce sitagliptin effectiveness by inducing metabolism.