Professional Documents
Culture Documents
in Type 2 Diabetes
FDA Approval:
Sitagliptin
Sitagliptin (2006, Januvia )
Sitagliptin + Glucophage (2007)
Vildagliptin (not approved in USA)
Saxagliptin
Saxagliptin (Onglyza)
Saxagliptin +/- metformin, sulfonylurea,
thiazolidinedione
Linagliptin (2011, Tradjenta)
Alogliptin (2013)
Mechanism of Action
Insulinotropic Glucose Glucagon
effect suppression
DPP-4
GLP-1
appetite glucose
uptake
insulin
glucagon
glucose
gastric poduction
emptying
Inactive
DPP-4
metabolites
inhibitor
GLP-1
appetite
DPP-4
glucose
uptake
insulin
glucagon
glucose
gastric poduction
emptying
Pharmacokinetics
Rapidly absorbed after oral administration
Peak plasma concentration 1- 4 hours
Active
- - Yes - -
metabolites
Renal
*
excretion
Dose
adjustment in
25-50 mg - 2,5 mg - -
renal
insufficiency
Drug interaction - - Yes** - -
Tablets Duration
Perkeni, 2015
CONTRAINDICATION
• Hipersensitivity
• DM type 1
• Ketoacidosis
WARNING
• Elderly (reduced renal and liver function)
• Pregnancy
• Breastfeeding
Side Effects / Adverse Effects
Headache, nausea
Hypersensitivity
Minor hypoglycaemia
A small increase in neutrophil count
(~200 cells/µL)
• Ketoconazole
• Itraconazole
… Except for saxagliptin • Atazanvir
• Indinavir
CYP3A4/5 inihibitors increase saxagliptin • Saquinavir
• Nelfinavir
in plasma • Ritonavir
Therefore need dose reduction to 2,5 mg/day • Nefazodone
• Telithromycin
• Clarithromycin
Blood Glucose
Fasting glucose
Hypoglycemia ± ±
Gastrointestinal symptoms ±
Risk of use in patients renal Severe Reduce dosage
insufficiency
Weight gain ±
Drug-drug interactions ± ±
Pros
Pricing….?
Conclusion
Conclusion
Conclusion
May be used for monotherapy
Equally effective as metformin
Still inferior compared to sulfonylurea 3 months cannot
reach HbA1c target
Preventive Measures
Check HbA1c
Per 12 weeks If target is not achieved combine with
other oral antidiabetic agents