From the Guidelines
Sitagliptin should be used with caution in patients with kidney disease, as it requires dose adjustment in patients with moderate to severe renal impairment [ 1 ].
Precautions for Sitagliptin
- Dose Adjustment: The recommended dose of sitagliptin is 100 mg once daily, but this may need to be reduced to 50 mg once daily in patients with moderate renal impairment (eGFR 30-44 mL/min/1.73 m2) and to 25 mg once daily in patients with severe renal impairment (eGFR 15-29 mL/min/1.73 m2) [ 1 ].
- Renal Function Monitoring: It is recommended to monitor renal function before initiating sitagliptin, and to adjust the dose accordingly [ 1 ].
- Pancreatitis Risk: Sitagliptin may increase the risk of pancreatitis, and patients should be advised to report any symptoms of pancreatitis, such as abdominal pain, nausea, and vomiting, and to seek medical attention immediately if they experience any of these symptoms [ 1 ].
- Heart Failure: Sitagliptin should be used with caution in patients with heart failure, as it may increase the risk of heart failure hospitalization [ 1 ]. Some key points to consider when prescribing sitagliptin include:
- Sitagliptin is a DPP-4 inhibitor, which can be used in patients with type 2 diabetes mellitus [ 1 ].
- Sitagliptin has been associated with a reduced risk of hypoglycemia compared to other glucose-lowering medications [ 1 ].
From the FDA Drug Label
History of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema. [See Warnings and Precautions (5.4); Adverse Reactions (6.2).] The precautions for Sitagliptin include a history of:
- Serious hypersensitivity reaction
- Anaphylaxis
- Angioedema 2
From the Research
Precautions for Sitagliptin
- Sitagliptin is recommended for initial and maintenance dosing at 100 mg daily, with downward dose adjustment recommended in patients with moderate or severe renal insufficiency 3.
- Patients with moderate renal insufficiency should receive sitagliptin 50 mg once daily, and patients with severe renal insufficiency should receive 25 mg once daily 4.
- The risk of congestive heart failure was not higher in older adults with chronic kidney disease (CKD) starting sitagliptin at >50 versus ≤50 mg/d 5.
- Sitagliptin treatment was not associated with an increased risk for the known cardiovascular disease risk factors of hypoglycaemia and bodyweight gain 6.
- In patients with type 2 diabetes and chronic kidney disease, sitagliptin was generally well tolerated, with no meaningful differences in safety outcomes observed between those assigned to sitagliptin or placebo 7.
Special Considerations
- Patients with CKD had higher incidences of serious adverse events and diabetes complications than those without CKD 7.
- The incidence of adverse events such as hypoglycaemia, pancreatitis, and severe hypoglycaemia was similar between sitagliptin- and placebo-assigned participants with CKD 7.
- Sitagliptin is generally well tolerated, with most adverse events being of mild to moderate intensity and relatively few patients discontinuing treatment because of these events 6.