Metformina + Sitagliptina Disitfor (Metformin Hydrochloride, Sitagliptin)

Metformina + Sitagliptina is used in the treatment of type 2 diabetes mellitus, acting on glucose metabolism pathways.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose when combined with diet and exercise.
• Inadequate control on metformin alone: provides additional glucose‑lowering effect as add‑on therapy.
• Combination therapy: simplifies regimen by delivering metformin and sitagliptin in a single tablet.

• Metformin decreases hepatic gluconeogenesis and improves peripheral insulin sensitivity, while sitagliptin inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), leading to increased levels of incretin hormones (GLP‑1 and GIP) that enhance glucose‑dependent insulin secretion and suppress glucagon release, together producing improved glycemic control.

Common Side Effects

• Gastrointestinal upset: nausea, abdominal discomfort, or diarrhea.
• Headache or dizziness.
• Upper respiratory tract infection symptoms.
• Mild hypoglycemia, especially when combined with other antidiabetic agents.
• Skin rash or pruritus.
• Elevated liver enzymes.

Serious or Rare Side Effects

• Lactic acidosis, a rare but life‑threatening condition.
• Severe hypoglycemia, particularly with insulin or sulfonylureas.
• Acute pancreatitis presenting with abdominal pain.
• Anaphylactic reactions or severe skin reactions such as Stevens‑Johnson syndrome.
• Significant renal impairment worsening drug clearance.
• Hepatic failure with marked transaminase elevation.

Metformina + Sitagliptina should be used with caution in patients with renal or hepatic impairment, as these conditions affect drug clearance and increase risk of lactic acidosis.

• Renal function: assess eGFR before initiation and periodically thereafter.
• Hepatic disease: avoid in patients with active liver disease.
• Cardiovascular risk: monitor for signs of heart failure.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk.
• Concomitant medications: review for drugs that may increase risk of hypoglycemia or affect renal function.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Metformina + Sitagliptina may interact with several medicines that alter its efficacy or safety profile.

Major Interactions (Avoid)

• Iodinated contrast agents: may precipitate lactic acidosis; discontinue metformin before and after use.
• Insulin or sulfonylureas: increase risk of severe hypoglycemia.
• Alcohol abuse: heightens lactic acidosis risk.

Moderate Interactions (Monitor Closely)

• Cimetidine or other renal‑clearance reducing agents: may raise metformin plasma levels.
• ACE inhibitors or ARBs: monitor renal function and potassium.
• Diuretics: assess for dehydration and renal function changes.
• Other antidiabetic agents: adjust dosing to avoid hypoglycemia.
• CYP3A4 inhibitors (e.g., ketoconazole): may affect sitagliptin metabolism.