From the Guidelines
The maximum dose of sitagliptin for patients with impaired renal function should be adjusted based on the severity of renal impairment, with a maximum dose of 50 mg daily for patients with moderate renal impairment (eGFR 30-44 mL/min/1.73 m2) and 25 mg once daily for patients with severe renal impairment (eGFR 15-29 mL/min/1.73 m2) or end-stage renal disease requiring hemodialysis (eGFR <15 mL/min/1.73 m2). According to the most recent and highest quality study 1, the dose adjustments for sitagliptin are as follows:
- For patients with stage 3b renal impairment (eGFR 30-44 mL/min/1.73 m2), the maximum dose of sitagliptin is 50 mg daily.
- For patients with stage 4 renal impairment (eGFR 15-29 mL/min/1.73 m2), the maximum dose of sitagliptin is 25 mg once daily.
- For patients with stage 5 renal impairment (eGFR <15 mL/min/1.73 m2), the maximum dose of sitagliptin is 25 mg once daily. These dose adjustments are necessary to minimize the risk of adverse effects associated with increased sitagliptin exposure in patients with impaired renal function. Some key points to consider when using sitagliptin in patients with renal impairment include:
- Sitagliptin is primarily eliminated via the kidneys, and reduced renal function can lead to increased drug exposure.
- The risk of adverse effects, such as hypoglycemia and pancreatitis, may be increased in patients with impaired renal function.
- Renal function should be assessed before initiating sitagliptin therapy and periodically thereafter, as changes in kidney function may necessitate dose adjustments. It's worth noting that other studies, such as 1, 1, and 1, also provide guidance on the use of sitagliptin in patients with renal impairment, but the most recent and highest quality study 1 provides the most up-to-date and relevant information.
From the Research
Maximum Dose of Sitagliptin
The maximum dose of sitagliptin for patients with normal renal function is 100 mg once daily 2, 3.
Dose Adjustment for Renal Impairment
For patients with impaired renal function, the dose of sitagliptin needs to be adjusted:
- For patients with moderate renal impairment (creatinine clearance ≥30 to <50 ml/min), the recommended dose is 50 mg once daily 2, 4.
- For patients with severe renal impairment (creatinine clearance <30 ml/min), the recommended dose is 25 mg once daily 2, 4.
Key Points
- Sitagliptin is generally well tolerated and effective in improving glycemic control in patients with type 2 diabetes 2, 4, 5.
- The dose of sitagliptin should be adjusted based on renal function to minimize the risk of adverse effects 2, 4.
- Sitagliptin has a low risk of hypoglycemia, except when used in combination with other agents that may increase the risk of hypoglycemia 5, 3.