Names and pronunciation
(sit-a-glip′tin/met-for′-min) Janumet, Janumet XR
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Drug reference
(sit-a-glip′tin/met-for′-min) Janumet, Janumet XR
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Func. class.: Antidiabetic Func. class.: Alkalinizer
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USES: Adjunct to diet and exercise to improve glycemic control in type 2 dia- betes mellitus USES: Acidosis (metabolic), cardiac arrest, alkalinization (systemic/urinary), S antacid, salicylate poisoning
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Chem. class.: NaHCO3
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ACTION: Orally neutralizes gastric acid, which forms water, NaCl, CO2; increases plasma bicarbonate, which buffers H+ ion concentration; reverses acidosis IV
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CONTRAINDICATIONS Hypersensitivity to sitagliptin, metformin, or any component, eGFR <30 mL/ min/1.73 m2); acute/chronic metabolic acidosis, diabetic ketoacidosis CONTRAINDICATIONS: Meta- bolic/respiratory alkalosis, hypochlore- mia, hypocalcemia Precautions: Pregnancy, children, HF, cirrhosis, toxemia, renal disease, hyper- tension, hypokalemia, breastfeeding, hypernatremia, Bartter’s syndrome, Cushing syndrome, hyperaldosteronism
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Black Box Warning: Lactic acidosis
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SIDE EFFECTS CNS: Irritability, headache, confusion, stimulation, tremors, twitching, hyper- reflexia, tetany, weakness, seizures of alkalosis CV: Irregular pulse, cardiac arrest, water retention, edema, weight gain GI: Flatulence, belching, distention META: Metabolic alkalosis MS: Muscular twitching, tetany, irrita bility
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INTERACTIONS Increase: effects—amphetamines, meca- mylamine, quiNINE, quiNIDine, pseudo- ephedrine, flecainide, anorexiants, sympathomimetics Increase: sodium and decrease potassium—corticosteroids Decrease: effects—lithium, chlorpro PAMIDE, barbiturates, salicylates, benzo- diazepines, ketoconazole, corticosteroids Drug/Lab Test Increase: sodium, lactate Decrease: potassium
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DOSAGE AND ROUTES Diabetes mellitus, type 2, treatment Total daily dose should be taken divided bid (immediate release) or daily (ex- tended release) • Adult: PO patients already on metformin: Sitagliptin 100 mg/day plus current daily dose of metformin. Patients currently on metformin 1.7 g/ day (850 mg bid) may use sitagliptin 100 mg/metformin 2 g daily; those not on metformin: Sitagliptin 100 mg/metformin 1 g daily DOSAGE AND ROUTES Conversions: 84 mg = 1 mmol (1 mEq) = 1 mmol (1 mEq) each of sodium and bicarbonate 10 ms Acidosis, metabolic (not associated with cardiac arrest) • Adult/child: IV INFUSION 2-5 mEq/ kg over 4-8 hr depending on CO2, pH, ABGs Metabolic acidosis in chronic renal failure Adults: PO 0.5-1 mEq/kg/day (42-84 mg/ kg/day) in 2-3 divided doses or 650 or 1300 mg twice daily for a serum bicarbonate con- centration of 19-21 mEq/L or 18 mEq/L or less, respectively. Titrate dose up to 1950 mg 3 times daily to target serum bicarbonate concentration (22 mEq/L or more) Infants, children, and adolescents: PO 1-2 mEq/kg/day (84-168 mg/kg/day) in 2-3 divided doses. Titrate dose to tar- get serum bicarbonate concentration Cardiac arrest • Adult/child: IV BOL 1 mEq/kg of 7.5% or 8.4% sol, then 0.5 mEq/kg q10min, then doses based on ABGs • Infant: IV 1 mEq/kg over several min (use only the 0.5 mEq/mL [4.2%] sol for inj) Alkalinization of urine • Adult: PO 325 mg to 2 g qid or 48 mEq (4 g), then 12-24 mEq q4hr • Child: PO 84-840 mg/kg/day (1-10 mEq/kg) in divided doses q4-6hr Antacid • Adult: PO 300 mg to 2 g chewed, taken with water daily-qid
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Available forms: Tabs 50/500, 50/1000 mg; tabs ext rel 50/500, 50/1000, 100/1000 mg Baking soda, Alka-Seltzer Accusol Bibag Bicort Available forms: Tabs 300, 325, 600, 650 mg; inj 4.2%, 5%, 7.5%, 8.4%
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Administer: PO route • Chew antacid tablets and drink 8 oz water • Do not take antacid with milk because milk-alkali syndrome may result Direct IV route • Use for cardiac emergencies, not used often in cardiac arrest • Use ampules or prefilled syringes only; give by rapid bolus dose; flush with NS before, after use Continuous IV INFUSION route • Diluted in an equal amount of compat- ible sol given 2-5 mEq/kg over 4-8 hr, max 50 mEq/hr; slower rate in children • Extravasation with IV administration (tissue sloughing, ulceration, necrosis) Y-site compatibilities: Acyclovir, amifos- tine, asparaginase, aztreonam, bivaliru- din, bumetanide, ceFAZolin, cefepime, cefTAZidime, ceftizoxime, cefTRIAXone, chloramphenicol, cimetidine, cladribine, clindamycin, cyclophosphamide, cyclo- SPORINE, cytarabine, DAPTOmycin, DAUNOrubicin, dexamethasone sodium phosphate, dexmedetomidine, digoxin, DOCEtaxel, DOXOrubicin, enalaprilat, ertapenem, erythromycin, esmolol, eto- poside, etoposide phosphate, famotidine, fentaNYL, filgrastim, fluconazole, flu darabine, furosemide, gallium nitrate, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone sodium succi- nate, ifosfamide, indomethacin, insulin, ketorolac, labetalol, levoFLOXacin, lido- caine, linezolid, LORazepam, magnesium sulfate, melphalan, mesna, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metoprolol, metroNI- DAZOLE, milrinone, morphine, nafcillin, nitroglycerin, nitroprusside, PACLitaxel, palonosetron, pantoprazole, PEME- trexed, penicillin G potassium, phenyl- ephrine, phytonadione, piperacillin/tazo- bactam, potassium chloride, procainamide, propranolol, propofol, protamine, raNITIdine, remifentanil, tacrolimus, teniposide, thiotepa, ticarcil- lin/clavulanate, tirofiban, tobramycin, tolazoline, vasopressin, vit B complex with C, voriconazole
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Assess: • Respiratory and pulse rate, rhythm, depth, lung sounds; notify prescriber of abnormalities • Fluid balance (I&O, weight daily, edema); notify prescriber of fluid over- load; assess for edema, crackles, short- ness of breath • Electrolytes, blood pH, PO2, HCO3− during treatment; ABGs frequently during emergencies • Weight daily with initial therapy • Alkalosis: irritability, confusion, twitch- ing, hyperreflexia stimulation, slow respi- rations, cyanosis, irregular pulse • Milk-alkali syndrome: confusion, headache, nausea, vomiting, anorexia, urinary stones, hypercalcemia • For GI perforation secondary to carbon dioxide in GI tract; may lead to perfora- tion if ulcer is severe enough • Pregnancy/breastfeeding: use as an antacid is considered unsafe; may breast- feed
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Evaluate: • Therapeutic response: ABGs, electro- lytes, blood pH, HCO3− WNL
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to take antacid with milk because milk-alkali syndrome may result; not to use antacid for >2 wk • To notify prescriber if indigestion ac- companied by chest pain; trouble breath- ing; diarrhea; dark, tarry stools; vomit that looks like coffee grounds; swelling of feet/ankles • About sodium-restricted diet; to avoid use of baking soda for indigestion
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PHARMACOKINETICS PO: Onset rapid, duration 10 min IV: Onset 15 min, duration 1-2 hr, excreted in urine
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• Adult: PO patients already on metformin: Sitagliptin 100 mg/day plus current daily dose of metformin. Patients currently on metformin 1.7 g/ day (850 mg bid) may use sitagliptin 100 mg/metformin 2 g daily; those not on metformin: Sitagliptin 100 mg/metformin 1 g daily DOSAGE AND ROUTES Conversions: 84 mg = 1 mmol (1 mEq) = 1 mmol (1 mEq) each of sodium and bicarbonate 10 ms Acidosis, metabolic (not associated with cardiac arrest)
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• Adult/child: IV INFUSION 2-5 mEq/ kg over 4-8 hr depending on CO2, pH, ABGs Metabolic acidosis in chronic renal failure Adults: PO 0.5-1 mEq/kg/day (42-84 mg/ kg/day) in 2-3 divided doses or 650 or 1300 mg twice daily for a serum bicarbonate con- centration of 19-21 mEq/L or 18 mEq/L or less, respectively. Titrate dose up to 1950 mg 3 times daily to target serum bicarbonate concentration (22 mEq/L or more) Infants, children, and adolescents: PO 1-2 mEq/kg/day (84-168 mg/kg/day) in 2-3 divided doses. Titrate dose to tar- get serum bicarbonate concentration Cardiac arrest
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• Adult/child: IV BOL 1 mEq/kg of 7.5% or 8.4% sol, then 0.5 mEq/kg q10min, then doses based on ABGs
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• Adult: PO 325 mg to 2 g qid or 48 mEq (4 g), then 12-24 mEq q4hr
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• Adult: PO 300 mg to 2 g chewed, taken with water daily-qid
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