Mifoglame (Sitagliptin)

Mifoglame (sitagliptin) belongs to the DPP‑4 inhibitor class and is employed in the management of type 2 diabetes mellitus.

• Type 2 diabetes mellitus: improves glycaemic control by enhancing insulin secretion and reducing glucagon release.
• Monotherapy in type 2 diabetes: can be used alone when diet and exercise are insufficient.
• Combination therapy: added to metformin or other oral agents to achieve target blood glucose levels.

• Sitagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones GLP‑1 and GIP. By preventing this degradation, sitagliptin raises circulating levels of GLP‑1 and GIP, leading to glucose‑dependent stimulation of insulin secretion, suppression of glucagon release, and overall improvement of post‑prandial and fasting blood glucose concentrations.

Sitagliptin is generally well tolerated, but several adverse reactions have been reported.

Common Side Effects

• Nasopharyngitis: mild upper respiratory tract infection symptoms.
• Headache: transient mild to moderate pain.
• Upper respiratory infection: cough, sore throat, or congestion.
• Gastrointestinal upset: nausea, abdominal discomfort, or diarrhoea.
• Dizziness: occasional light‑headed sensation.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Joint pain: unexplained arthralgia that may be persistent.
• Hepatic enzyme elevation: increased ALT/AST levels.
• Severe hypoglycaemia: especially when combined with insulin or sulfonylureas.

Before initiating sitagliptin therapy, clinicians should consider several safety aspects.

• Renal impairment: dose adjustment may be required in patients with reduced kidney function.
• Hepatic impairment: use with caution in moderate to severe liver disease.
• Concomitant insulin or sulfonylureas: monitor for hypoglycaemia.
• History of pancreatitis: avoid use and observe for symptoms.
• Pregnancy and lactation: safety not established; weigh benefits against risks.
• Store at ambient temperature: keep below 25°C, retain in original packaging, protect from moisture.

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

Major Interactions (Avoid)

• Insulin or sulfonylureas: increased risk of severe hypoglycaemia.
• Strong DPP‑4 inhibitors (e.g., saxagliptin): additive effect, not recommended.

Moderate Interactions (Monitor Closely)

• Rifampin: may reduce sitagliptin plasma concentrations.
• Diuretics: may affect glucose control, requiring monitoring.
• ACE inhibitors: potential for altered renal function, necessitating observation.