Sitagliptin

Sitagliptin is a dipeptidyl peptidase-4 (dpp-4) inhibitor — oral antidiabetic medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Sitagliptin is used to improve blood sugar control in adults with type 2 diabetes mellitus, together with diet and exercise. Your doctor may prescribe it:

• Alone, when metformin is not suitable or is not tolerated
• In combination with metformin, a sulfonylurea, pioglitazone or insulin, when one medicine is not enough

It is not used for type 1 diabetes or for diabetic ketoacidosis (a dangerous build-up of acids in the blood). The exact role of Sitagliptin in your treatment plan depends on your blood sugar levels, kidney function and other medicines, so always follow your doctor's advice.

Most people tolerate Sitagliptin well. Possible side effects include:

• Headache, blocked or runny nose, sore throat
• Nausea, stomach upset, diarrhoea or constipation
• Joint or muscle pain
• Low blood sugar (hypoglycaemia), mainly when Sitagliptin is combined with a sulfonylurea or insulin — watch for sweating, shakiness, hunger and palpitations

Rare but serious problems include inflammation of the pancreas (severe, persistent stomach pain that may spread to the back, with vomiting), serious allergic reactions (swelling of the face, lips or throat; widespread rash) and a blistering skin disease. Stop the medicine and seek medical help immediately if any of these occur.

Before starting Sitagliptin, tell your doctor if you have:

• Kidney disease or are on dialysis — the dose may need adjusting
• A history of pancreatitis, gallstones or very high triglycerides
• Heart failure or significant heart disease

Keep up regular blood sugar testing, HbA1c checks and kidney function tests as advised. Learn to recognise and treat low blood sugar if you also use insulin or a sulfonylurea, and keep glucose or sweets handy. Continue your diabetic diet and physical activity — Sitagliptin works alongside lifestyle changes, not instead of them. Do not stop or change the dose on your own, even if you feel well, because blood sugar can rise silently.

Sitagliptin has relatively few drug interactions, but always tell your doctor and pharmacist about every medicine you take, including herbal and over-the-counter products. Important points:

• Insulin and sulfonylureas (e.g. glimepiride, gliclazide): combining them with Sitagliptin increases the risk of low blood sugar; your doctor may lower their dose.
• Digoxin (a heart medicine): sitagliptin can slightly raise digoxin levels, so monitoring may be advised.
• Steroids, diuretics (water tablets) and some antibiotics can change blood sugar control, so doses may need review.

Do not start any new medicine without informing the doctor who manages your diabetes.

Do not take Sitagliptin if:

• You are allergic to Sitagliptin or any other ingredient of the product
• You previously had a serious allergic reaction to a DPP-4 inhibitor, such as anaphylaxis or swelling of the face, lips or throat (angioedema)

Sitagliptin must not be used to treat type 1 diabetes or diabetic ketoacidosis. If you develop severe, ongoing abdominal pain (possible pancreatitis), the medicine should be stopped and you should be assessed by a doctor before it is ever restarted. If you are unsure whether this medicine is safe for you, ask your physician or pharmacist first.

There is not enough reliable information about the safety of Sitagliptin in human pregnancy. For most pregnant women with diabetes, doctors prefer to control blood sugar with insulin, because it has the best-established safety record. If you are pregnant, planning a pregnancy or discover you are pregnant while taking Sitagliptin, contact your doctor promptly — do not simply stop the medicine, as uncontrolled blood sugar can also harm the baby.

It is not known whether sitagliptin passes into human breast milk. Discuss the risks and benefits with your doctor before breastfeeding while on Sitagliptin; an alternative treatment may be chosen.

Store Sitagliptin below 30°C in a cool, dry place, away from direct sunlight and moisture. Keep the medicine in its original blister or container until you are ready to take it, because humidity can damage it — avoid storing it in the bathroom or kitchen.

• Keep all medicines out of the reach and sight of children.
• Do not use the medicine after the expiry date printed on the pack.
• Do not throw unused medicine into household waste or drains; ask your pharmacist about safe disposal.