From the Guidelines
Yes, sitagliptin can be taken with glipizide, but with careful monitoring of blood glucose levels due to the increased risk of hypoglycemia. According to the most recent and highest quality study, 1, sitagliptin, a DPP-4 inhibitor, and glipizide, a sulfonylurea, can be used together for better blood sugar control in type 2 diabetes. However, this combination may increase the risk of hypoglycemia, so it is essential to monitor blood glucose levels carefully, especially when starting the combination.
Key Considerations
- Typical dosing is sitagliptin 100 mg once daily and glipizide 5-20 mg daily (often divided into two doses), but the doctor will determine the appropriate doses based on specific needs.
- Be alert for symptoms of low blood sugar such as shakiness, sweating, confusion, or dizziness, and have a quick source of glucose available.
- Always take these medications as prescribed and inform the healthcare provider about all other medications being taken to avoid potential interactions.
Dosing Adjustments
- According to 1, for patients with chronic kidney disease (CKD), the dose of sitagliptin should be adjusted based on the estimated glomerular filtration rate (eGFR). For example, the maximum dose of sitagliptin is 50 mg daily for patients with an eGFR of 30-44 mL/min/1.73 m2 and 25 mg once daily for patients with an eGFR of 15-29 mL/min/1.73 m2.
- Glipizide should also be initiated conservatively, with a starting dose of 2.5 mg once daily, and titrated slowly to avoid hypoglycemia.
Monitoring and Precautions
- Regular monitoring of blood glucose levels, kidney function, and liver function is essential when taking sitagliptin and glipizide together.
- Patients should be aware of the signs and symptoms of hypoglycemia and have a plan in place to manage it.
- The healthcare provider should be informed of any changes in medications, diet, or exercise to ensure safe and effective management of blood sugar levels.
From the Research
Sitagliptin and Glipizide Combination
- The combination of sitagliptin and glipizide has been studied in patients with type 2 diabetes mellitus 2.
- In one case report, a patient with type 2 diabetes mellitus received combination exenatide-sitagliptin with glipizide, resulting in significant improvements in self-monitored blood glucose readings and a reduction in HbA(1c) value from 13.4% to 7.4% 2.
- Another study compared the efficacy and safety of sitagliptin versus glipizide in patients with type 2 diabetes inadequately controlled on metformin alone, and found that sitagliptin was non-inferior to glipizide in reducing HbA(1c) levels 3.
Efficacy and Safety
- Sitagliptin has been shown to have a lower risk of hypoglycemia compared to glipizide when added to metformin therapy 4, 3.
- The combination of sitagliptin and glipizide may be effective in reducing HbA(1c) levels, but the risk of hypoglycemia should be carefully monitored 2, 4.
- Sitagliptin has also been associated with weight loss, whereas glipizide has been associated with weight gain 5, 3.
Clinical Considerations
- The decision to use sitagliptin with glipizide should be based on individual patient characteristics and medical history 2, 4.
- Patients should be closely monitored for hypoglycemia and other adverse effects when using the combination of sitagliptin and glipizide 4, 3.
- The efficacy and safety of the combination of sitagliptin and glipizide should be carefully evaluated in clinical practice 2, 3.