From the Guidelines
Januvia (Sitagliptin) is contraindicated in patients with a history of serious hypersensitivity reactions to sitagliptin, and its use requires caution in patients with moderate to severe renal impairment (eGFR <45 mL/min/1.73 m²), where dose adjustment is necessary, as indicated in the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Key Considerations
- Patients with type 1 diabetes or those requiring treatment for diabetic ketoacidosis should not use Januvia.
- Caution is advised in patients with a history of pancreatitis, as Januvia has been associated with acute pancreatitis in some cases.
- Patients with heart failure, particularly NYHA class III-IV, should use Januvia cautiously due to potential cardiovascular concerns.
- The medication should be used carefully in pregnant or breastfeeding women, as safety data is limited.
- Januvia may interact with certain medications like insulin or sulfonylureas, potentially increasing hypoglycemia risk, so dose adjustments of these agents may be needed when used concurrently.
Dose Adjustments for Renal Impairment
- For patients with stage 3b chronic kidney disease (eGFR 30–44 mL/min/1.73 m²), the maximum recommended dose of Januvia is 50 mg daily.
- For patients with stage 4 chronic kidney disease (eGFR 15–29 mL/min/1.73 m²), the maximum recommended dose of Januvia is 25 mg once daily.
- These dose adjustments are based on the package inserts and are intended to minimize the risk of adverse effects in patients with renal impairment, as outlined in the 2022 ADA and KDIGO consensus report 1.
From the FDA Drug Label
History of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema. The contraindications for Januvia (Sitagliptin) are:
- History of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema 2
From the Research
Contraindications for Januvia (Sitagliptin)
- There is no direct information on the contraindications for Januvia (Sitagliptin) in the provided studies 3, 4, 5, 6, 7.
- However, the studies mention that GLP-1 receptor agonists are contraindicated in those with a history of medullary thyroid cancer 3.
- It is also mentioned that SGLT2 inhibitors should be avoided where there is a risk of diabetic ketoacidosis 3.
- Additionally, GLP-1 receptor agonists should be used with caution in patients with a history of pancreatitis of a known cause 3.
- The studies do not provide specific contraindications for Sitagliptin, but they discuss the potential risks and benefits of using DPP-4 inhibitors, such as Sitagliptin, in patients with type 2 diabetes 4, 5.
- 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 5.