Perioperative Management of Januvia (Sitagliptin) for Surgery
Januvia (sitagliptin) can be safely continued up to the day of surgery and does not require preoperative discontinuation, as it does not increase risk of perioperative hypoglycemia or adverse cardiovascular events.
Pharmacological Considerations
- Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that works by increasing circulating incretins, which stimulate insulin secretion and inhibit glucose production 1
- Unlike some other antidiabetic medications, sitagliptin has a low risk of hypoglycemia when used as monotherapy and has a neutral effect on body weight 2
- Sitagliptin is generally well-tolerated with the most common side effects being gastrointestinal complaints (up to 16%), including abdominal pain, nausea, and diarrhea 1
Perioperative Recommendations
- There are no specific guidelines recommending discontinuation of sitagliptin before surgery, unlike other medications such as SGLT2 inhibitors which require discontinuation 3-4 days preoperatively 3
- A randomized controlled trial examining sitagliptin in cardiac surgery patients showed that administration of sitagliptin prior to surgery and during hospitalization was safe and did not increase perioperative complications 4
- Unlike medications such as angiotensin II antagonists which can cause significant hypotension during anesthesia induction and should be discontinued before surgery, sitagliptin does not have these hemodynamic effects 5
Benefits of Continuing Sitagliptin
- Continuing sitagliptin perioperatively may help maintain glycemic control during the stressful perioperative period 4
- In patients transitioning from ICU to regular wards after cardiac surgery, sitagliptin was associated with lower mean daily insulin requirements (21.1 ± 18.4 vs. 32.5 ± 26.3 units) compared to placebo 4
- Maintaining glycemic control perioperatively is important as it reduces the risk of surgical site infections and other adverse outcomes 3
Special Considerations
- For patients with renal impairment, dose adjustment may be necessary: 50 mg once daily for moderate renal impairment and 25 mg once daily for severe renal impairment 1
- Unlike some medications (such as metformin which has been historically discontinued before procedures with contrast media), there are no specific contraindications for sitagliptin in the perioperative period 2
- For patients unable to take oral medications immediately after surgery, sitagliptin should be resumed as soon as oral intake is possible 6
Comparison with Other Antidiabetic Medications
- Unlike SGLT2 inhibitors which should be discontinued 3-4 days before surgery to reduce the risk of perioperative metabolic acidosis, sitagliptin does not carry this risk 3
- Unlike sulfonylureas which can cause hypoglycemia if continued during periods of fasting, sitagliptin has a glucose-dependent mechanism of action that reduces this risk 1, 2
- Metformin can be continued during the perioperative period in most cases, similar to sitagliptin 3
In conclusion, Januvia (sitagliptin) can be safely continued up to the day of surgery without increasing perioperative risks, and should be resumed as soon as the patient can take oral medications postoperatively.