Sitagliptin
✅ Low hypoglycaemia risk when used alone (hypos mainly if combined with insulin / sulfonylurea).
⚠️ Pancreatitis: rare reports with DPP-4 inhibitors — counsel on symptoms and stop if suspected.
ℹ️ About
- Sitagliptin (Januvia) — DPP-4 inhibitor.
-
Always verify dosing/renal adjustment/interactions in the
BNF.
- Generally weight-neutral and suitable when avoiding hypos is a priority.
Mode of action
- Inhibits DPP-4 → ↑ endogenous incretins (GLP-1, GIP).
- Leads to glucose-dependent ↑ insulin secretion and ↓ glucagon (so hypos are uncommon unless combined with insulin/SU).
Indications
- Type 2 diabetes as monotherapy (if metformin inappropriate) or add-on to other glucose-lowering therapy (including insulin) when control remains above target.
Dose
- Standard: 100 mg once daily.
- Renal adjustment (eGFR):
- 30–45 mL/min/1.73m² → 50 mg once daily
- <30 mL/min/1.73m² → 25 mg once daily
- Elderly: no routine “elderly dose” — dose by renal function; review benefit vs burden regularly.
Prescribing advice
- Low hypo risk and usually weight neutral.
- If used with a sulfonylurea or insulin, consider reducing those doses to reduce hypoglycaemia risk.
- Local formulary choice varies; linagliptin is often preferred in severe renal impairment because it typically needs no dose adjustment.
Contraindications
- Diabetic ketoacidosis / type 1 diabetes (not indicated).
- Known serious hypersensitivity to sitagliptin.
Cautions
- Renal impairment: adjust dose to eGFR and monitor renal function.
- Pancreatitis: advise to seek urgent review for persistent severe abdominal pain (± radiating to the back).
Interactions
- See BNF (interaction burden is usually modest, but check concomitant medicines).
Side effects
- Headache, GI upset, URTI-like symptoms (variable).
- Stop if pancreatitis suspected; investigate and report via Yellow Card where appropriate.
References
