From the Guidelines
Janovia 25 mg (sitagliptin) may be appropriate for someone with kidney failure, but the dose should be adjusted based on kidney function, as sitagliptin is primarily eliminated through the kidneys, and reduced kidney function leads to higher blood levels of the medication 1. To determine the appropriate dose, a healthcare provider needs to evaluate the patient's specific kidney function (measured by eGFR or creatinine clearance).
- For mild kidney impairment, no dose adjustment is needed.
- For moderate kidney impairment, the dose is typically reduced to 50 mg once daily.
- For severe kidney impairment or end-stage renal disease, the recommended dose is 25 mg once daily. The patient should consult their nephrologist or endocrinologist for personalized dosing recommendations based on their exact kidney function measurements and overall health status, as supported by recent guidelines 1. It is also important to note that sitagliptin has been shown to be effective in reducing HbA1c levels in patients with type 2 diabetes, with a neutral or mild effect on weight gain and no increased risk of hypoglycemia 1. However, the use of sitagliptin in patients with renal dysfunction requires careful consideration and dose adjustment to minimize the risk of adverse effects, as highlighted in previous studies 1.
From the Research
Janovia 25 mg in Kidney Failure
- The use of sitagliptin (Janovia) in patients with kidney failure has been studied in several clinical trials 2, 3, 4.
- In a 54-week study, patients with moderate to severe renal insufficiency, including those with end-stage renal disease (ESRD) on dialysis, were treated with sitagliptin 25 mg or 50 mg once daily 2.
- The results showed that sitagliptin was generally well tolerated and provided effective glycaemic control in these patients, with a low risk of hypoglycaemia 2.
- Another study found that sitagliptin was effective in reducing HbA1c levels in patients with type 2 diabetes and moderate to severe renal insufficiency, with a dose adjustment to 25 mg once daily for patients with severe renal insufficiency 3.
- A review of sitagliptin in type 2 diabetes noted that the drug is generally well tolerated in patients with renal impairment, with a low risk of adverse events 4.
- However, a study on the use of antihyperglycemic medications in patients with renal impairment found that sitagliptin was often used at inappropriate doses in these patients, highlighting the need for careful dose adjustment in patients with kidney failure 5.
Dose Adjustment in Kidney Failure
- The recommended dose of sitagliptin for patients with moderate renal insufficiency is 50 mg once daily, and for patients with severe renal insufficiency, the recommended dose is 25 mg once daily 2, 3.
- It is essential to monitor renal function and adjust the dose of sitagliptin accordingly to minimize the risk of adverse events 5.
- Healthcare providers should carefully evaluate the benefits and risks of using sitagliptin in patients with kidney failure and adjust the dose as needed to ensure safe and effective treatment 4.