From the Guidelines
Sitagliptin requires dose adjustment in patients with chronic kidney disease (CKD), with the dose reduced to 50 mg once daily for moderate renal impairment (eGFR 30-59 mL/min/1.73m²) and 25 mg once daily for severe renal impairment (eGFR <30 mL/min/1.73m²) or end-stage renal disease requiring dialysis. According to the most recent and highest quality study 1, the dose adjustments for sitagliptin in CKD are as follows:
- For patients with mild renal impairment (eGFR >50 mL/min/1.73m²), the standard dose of 100 mg once daily can be used.
- For patients with moderate renal impairment (eGFR 30-50 mL/min/1.73m²), the dose should be reduced to 25-50 mg once daily.
- For patients with severe renal impairment (eGFR <30 mL/min/1.73m²) or end-stage renal disease requiring dialysis, the dose should be further reduced to 25 mg once daily. These dose adjustments are necessary to minimize the risk of adverse effects, including hypoglycemia, and to optimize glycemic control in patients with CKD. Regular monitoring of kidney function is essential to adjust the dose of sitagliptin accordingly if renal function changes over time 1.
Some key points to consider when adjusting the dose of sitagliptin in CKD include:
- The dose of sitagliptin should be reduced in patients with moderate to severe renal impairment to minimize the risk of adverse effects.
- The dose of sitagliptin should be adjusted based on the patient's estimated glomerular filtration rate (eGFR).
- Regular monitoring of kidney function is essential to adjust the dose of sitagliptin accordingly if renal function changes over time.
- Sitagliptin is primarily eliminated by the kidneys, and reduced kidney function leads to increased drug concentrations in the blood, which can increase the risk of adverse effects.
From the Research
Sitagliptin Dosage Adjustment for CKD
- Sitagliptin is a dipeptidylpeptidase-4 inhibitor used in the management of type 2 diabetes, and its dosage may need to be adjusted in patients with chronic kidney disease (CKD) 2, 3, 4.
- The drug is primarily eliminated by the kidney, and a reduced dose is recommended for patients with CKD 4, 5.
- Studies have shown that sitagliptin can be used safely in patients with moderate-to-severe CKD, with appropriate dose reductions 3, 4.
- The recommended dose of sitagliptin for patients with moderate renal insufficiency is 50 mg every day, and for severe renal insufficiency, it is 25 mg every day 3.
Dosing Adjustments for CKD
- Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes 6.
- Dosages of drugs cleared renally, such as sitagliptin, should be adjusted according to creatinine clearance or glomerular filtration rate 6.
- Recommended methods for maintenance dosing adjustments include dose reductions, lengthening the dosing interval, or both 6.
Clinical Evidence
- A study comparing the efficacy and safety of sitagliptin with glipizide in patients with type 2 diabetes and moderate-to-severe CKD found that sitagliptin was noninferior to glipizide in terms of A1C change from baseline 3.
- Another study found that sitagliptin was associated with a lower risk of symptomatic hypoglycemia and weight loss compared to glipizide in patients with type 2 diabetes and CKD 3.
- A review article summarized the use of sitagliptin in clinical practice, including its use in patients with CKD, and emphasized the need for dose reductions in patients with moderate-to-severe renal impairment 4.