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Sitagliptin or Januvia is an oral medication used to lower blood glucose levels in people living with type 2 diabetes.
What is Sitagliptin?
Sitagliptin is also known by the brand name Januvia. It was the first of a family of drugs called DPP-4 inhibitors or gliptins. Your doctor may prescribe Sitagliptin once a day if your type 2 diabetes isn’t controlled by lifestyle measures and other types of oral medications like Metformin.
Other gliptins include Saxagliptin and Vildagliptin, but the whole family of drugs all work to control your glucose levels in the same way.
How does Sitagliptin work?
Sitagliptin improves the health of the insulin-producing beta cells in the pancreas. It suppresses the production of the hormone glucagon, which works to prevent blood glucose levels from falling. As a result, glucose levels are lower, and there’s less of a sugar spike after a meal.
Gliptins work by augmenting the incretin system. Sitagliptin blocks the action of DPP-4, an enzyme called dipeptidyl peptidase-4 (DPP-4), which breaks down incretin hormones in the body. Incretins are important gut peptides that make the body release two to three times more insulin when you eat rather than inject glucose. In people with type 2 diabetes, this incretin effect is reduced or absent. By blocking DPP-4, incretin levels in the body increase, and your body produces more insulin and less glucose.
What is Sitagliptin used for?
Together with diet and exercise, Sitagliptin can help lower your blood glucose and improve your diabetes control. Gliptins are usually used for people whose diabetes is poorly controlled by other medications like Metformin, despite eating well and exercising regularly.
If you have type 2 diabetes, are taking Metformin, and your HbA1c is above the target of 6.5% or 48mmol/mol, the National Institute for Health and Care Excellence (NICE) suggests adding in Sitagliptin to help achieve better control.
Clinical trials looked at adults with type 2 diabetes whose HbA1c wasn’t controlled with Metformin, diet and exercise. Adding Sitagliptin helped people have significantly lower A1C levels. As well as helping to control diabetes, it also reduces the risk of the long term complications of diabetes, including major problems like a heart attack or stroke.
How to take Sitagliptin
Sitagliptin is taken as an oral tablet once a day. You can take it at any time, with or without meals. However, it’s better to take it at around the same time every day.
It comes as 25mg, 50mg and 100mg tablets. The usual dose is 100mg a day, but you may need less if you have reduced kidney function.
Swallow the tablet whole, without chewing or breaking it, with a glass of water. If you forget your tablet take it when you remember- but if it’s close to your next dose, skip a tablet. It’s important not to double up.
Sitagliptin is effective and well-tolerated by most patients. The advantages of gliptin treatment include:
- Better diabetes control and a significantly reduced HbA1c by between 0.5 and 2%
- Does not cause weight gain
- Unlikely to cause significant hypoglycemia
- Available as a combination medication with Metformin for easy administration
Sitagliptin side effects
All medications come with side effects. Your diabetes team should take you through the pros and cons of the treatment so that you can make an informed choice about your medication. Sitagliptin should be avoided in people with type 1 diabetes, diabetic ketoacidosis or a history of pancreatitis.
Your doctor will monitor your health and may take some blood tests to check your liver and kidney function before starting treatment with some gliptins like Saxagliptin, Vildagliptin, or Alogliptin. If you experience worrying symptoms, get in touch with your diabetes team or call 111 for advice.
Adverse effects include:
- Gastrointestinal disturbance is a relatively common side effect. You may experience constipation, vomiting, nausea, diarrhoea, indigestion
- Acute pancreatitis is an uncommon but serious complication; you should get urgent medical advice if you develop severe pain in your upper abdomen
- Liver inflammation- see a doctor if you develop jaundice with yellowing of the eyes and skin, pale stools and dark urine
- Headache, dizziness, and a tremor. Headache is the most common side effect, with one in a hundred people affected. See your GP if your headache is severe or lasts more than seven days
- Itchy rash and angioedema
- Back pain, muscle aches and joint pain
- Allergies and hypersensitivity reactions
- Lung disease
- Impaired renal function
- Low platelets, bruising and bleeding
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