Metformina + Sitagliptina Krka (Metformin Hydrochloride, Sitagliptin)

Metformina + Sitagliptina Krka is used in the treatment of type 2 diabetes mellitus, a chronic metabolic disorder that impairs glucose regulation. It helps achieve glycaemic targets when combined with lifestyle measures.

• Type 2 diabetes mellitus: improves fasting and post‑prandial glucose levels and reduces HbA1c.
• Inadequate control on metformin alone: provides additional glucose‑lowering effect.
• Adjunct to diet and exercise: supports overall metabolic management.

• Metformin decreases hepatic gluconeogenesis and enhances peripheral insulin sensitivity, while sitagliptin inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), leading to increased endogenous incretin hormones (GLP‑1 and GIP). The elevated incretins promote glucose‑dependent insulin secretion and suppress glucagon release, together producing improved glycaemic control.

The combination may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Gastrointestinal upset: nausea, abdominal discomfort, or flatulence.
• Diarrhoea: loose stools occurring especially after therapy initiation.
• Upper respiratory symptoms: nasopharyngitis or mild cough.
• Headache: transient cranial pain.
• Decreased appetite: reduced food intake.
• Metallic taste: altered taste perception.

Serious or Rare Side Effects

• Lactic acidosis: rare but life‑threatening metabolic disturbance.
• Severe hypoglycaemia: especially when combined with insulin or sulfonylureas.
• Acute pancreatitis: sudden abdominal pain with elevated enzymes.
• Hepatic failure: signs of liver dysfunction.
• Stevens‑Johnson syndrome or toxic epidermal necrolysis: severe skin reactions.
• Anaphylactic reaction: rare systemic allergic response.

Patients should be evaluated for specific risk factors before initiating therapy and monitored regularly during treatment.

• Renal function: assess eGFR and avoid use in severe renal impairment.
• Hepatic impairment: use with caution; monitor liver enzymes.
• Risk of lactic acidosis: avoid in conditions predisposing to hypoxia or dehydration.
• Pregnancy and lactation: safety not established; weigh benefits against risks.
• Concomitant medications: review for potential interactions, especially with insulin or sulfonylureas.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Metformina + Sitagliptina Krka may interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Insulin or sulfonylureas: increased risk of severe hypoglycaemia.
• Iodinated contrast agents: may precipitate acute renal failure, raising lactic acidosis risk.
• Cimetidine: can elevate metformin plasma concentrations.

Moderate Interactions (Monitor Closely)

• Diuretics: may affect renal clearance of metformin.
• Corticosteroids: can raise blood glucose, reducing efficacy.
• ACE inhibitors or ARBs: monitor renal function and potassium levels.
• Rifampicin: may reduce sitagliptin levels.
• Anticoagulants (e.g., warfarin): monitor INR as glycaemic changes can affect coagulation.