Names and pronunciation
(al′oh-glip′tin) Nesina
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Drug reference
(al′oh-glip′tin) Nesina
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Func. class.: Antidiabetic
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Chem. class.: Dipeptidyl peptidase-4 (DPP-4) inhibitor
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ACTION: A dipeptidyl-peptidase-IV (DDP-IV) inhibitor potentiates the effects of the incretin hormones by inhib- iting their breakdown by DDP-IV
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USES: Type 2 diabetes mellitus (T2DM)
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CONTRAINDICATIONS: Hyper- sensitivity, ketoacidosis, type 1 diabetes Precautions: Pregnancy, breastfeeding, hepatic disease, burns, diarrhea, fever, GI obstruction, hyper/hypoglycemia, hyper/ hypothyroidism, hypercortisolism, chil- dren, ileus, malnutrition, pancreatitis, surgery, trauma, vomiting, kidney disease, adrenal insufficiency, angioedema
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SIDE EFFECTS CNS: Headache GI: Pancreatitis, hepatotoxicity CV: Heart failure SYST: Rash, hypersensitivity, angioedema, Stevens-Johnson syndrome, anaphylaxis
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INTERACTIONS Increase: hypoglycemia—insulin, andro- gens, pegvisomant, sulfonylureas; dosage adjustment may be needed Decrease: hypoglycemia—danazol, thia- zides; adjust dose Drug/Lab Test Increase: LFTs Decrease: glucose
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DOSAGE AND ROUTES A • Adult: PO 25 mg/day Renal dose • Adult: PO CCr 30-59 mL/min: 12.5 mg every day; CCr <30 mL/min: 6.25 mg ev- ery day; intermittent hemodialysis: 6.25 mg every day; give without regard to the timing of hemodialysis
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Available forms: Tablets 6.25, 12.5, 25 mg
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Administer: • Without regard to food
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Assess: • Diabetes: monitor blood glucose, gly- cosylated hemoglobin A1c (A1c), LFTs, serum creatinine/BUN baseline and throughout treatment • Pancreatitis: can occur during use; monitor for severe abdominal pain, with or without vomiting • Hypersensitivity reactions: angio edema, Stevens-Johnson syndrome; prod- uct should be discontinued • HF: Assess for risk of HF in those with known HF or kidney disease
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Evaluate: • Positive therapeutic response: decrease in polyuria, polydipsia, polyphagia, clear sensorium, absence of dizziness, improvement in A1c
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Hepatotoxicity: To report yellowing of skin, eyes, dark urine, clay-colored stools, nausea, vomiting • That diabetes is a lifelong condition, product does not cure disease • That all food in diet plan must be eaten to prevent hypoglycemia; to con- tinue with weight control, dietary medical nutrition therapy, physical activity, hygiene • To carry emergency ID with pre- scriber, medications, and condition listed • To test blood glucose using a blood glucose meter, and urine ketones • To report allergic reactions, nausea, vomiting, abdominal pain, dark urine • Hypersensitivity: To notify health care professional and stop taking product if rash, trouble breathing, swelling of face, lips, tongue occur • To notify all health care professionals of OTC, Rx, herbs, supplements used • Pregnancy/breastfeeding: To report if pregnancy is planned or suspected, or if breastfeeding
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PHARMACOKINETICS 20% protein binding, excreted unchanged (urine), peak 1-2 hr, duration up to 24 hr, effect decreased in liver disease and increased in kidney disease, half-life 21 hr
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• Adult: PO 25 mg/day Renal dose
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• Adult: PO CCr 30-59 mL/min: 12.5 mg every day; CCr <30 mL/min: 6.25 mg ev- ery day; intermittent hemodialysis: 6.25 mg every day; give without regard to the timing of hemodialysis
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