Names and pronunciation
(sit-a-glip′tin) Januvia
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Individual generic drug information
Extracted information for sitaGLIPtin only.
(sit-a-glip′tin) Januvia
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Func. class.: Antidiabetic, oral
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Chem. class.: Dipeptidyl-peptidase-4 inhibitor (DPP-4 inhibitor)
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Do not confuse: Januvia/Enjuvia/Jantoven/Janumet
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ACTION: Slows the inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin secretion, lowers glucagon secre- tions, and slows gastric emptying time
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USES: Type 2 diabetes mellitus as monotherapy or in combination with other antidiabetic agents
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Extracted information for sitaGLIPtin only.
CONTRAINDICATIONS: Angio- edema, diabetic ketoacidosis (DKA) Precautions: Pregnancy, geriatric patients, GI obstruction, surgery, thyroid/ renal/hepatic disease, trauma, breast- feeding, pancreatitis, hypercortisolism, hyperglycemia, hyperthyroidism, hypo- glycemia, ileus, pituitary insufficiency, surgery, type 1 diabetes mellitus, diabetic ketoacidosis, adrenal insufficiency, burns
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SIDE EFFECTS CNS: Headache ENDO: Hypoglycemia GI: Nausea, vomiting, abdominal pain, diarrhea, pancreatitis, constipation GU: Acute renal failure, UTI MISC: Peripheral edema, upper respi- ratory infection SYST: Anaphylaxis, Stevens-Johnson syn drome, angioedema
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INTERACTIONS Increase: levels of digoxin (minimal) Increase: hypoglycemia—antidiabetics, chloroquine, hydroxychloroquine, androgens, beta-blockers, salicylates, MAOIs Increase: sitagliptin level—cimetidine, disopyramide Decrease: antidiabetic action thiazides, ACE inhibitors, protease inhibitors, estrogens, progestins, hormonal contra- ceptives, sympathomimetics Drug/Herb Increase: antidiabetic effect—garlic, green tea, horse chestnut Drug/Lab Test Increase: creatinine, LFTs
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Extracted information for sitaGLIPtin only.
DOSAGE AND ROUTES • Adult: PO 100 mg/day; lower dose may be needed when used with a sulfo- nylurea or insulin Renal dose • Adult: PO CCr 30-50 mL/min, 50 mg daily; CCr <30 mL/min, 25 mg daily
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Available forms: Tabs 25, 50, 100 mg
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Administer: • May be taken with/without food • Do not split, crush, chew; swallow whole • Conversion from other antidiabetic agents: change may be made with grad- ual dosage change • Store in tight container at room tem- perature
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Extracted information for sitaGLIPtin only.
Assess: • Hypoglycemic reactions: sweating, weakness, dizziness, anxiety, tremors, hun- ger; hyperglycemic reactions soon after meals • Serious skin reactions: swelling of face, mouth, lips; dyspnea; wheezing • Pancreatitis: severe abdominal pain, nausea, vomiting; discontinue product, monitor amylase, lipase • Renal studies: BUN, creatinine during treatment, especially in geriatric patients or those with renal disease • Glycosylated hemoglobin A1c; monitor blood glucose (BG) as needed
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Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait, blood glucose, A1c improvement
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To perform regular self-monitoring of blood glucose using blood-glucose meter • About the symptoms of hypo/hypergly- cemia; what to do about each; to carry emergency ID • To report severe joint pain immediately; may have a late onset • That product must be continued on daily basis; about consequences of dis- continuing product abruptly; to continue health regimen (diet, exercise) • To avoid OTC medications, alcohol, digoxin, exenatide, insulins, nateglinide, repaglinide, and other products that lower blood glucose unless approved by prescriber • That diabetes is a lifelong illness; that product is not a cure, only controls symptoms • That all food included in diet plan must be eaten to prevent hypo/hypergly- cemia • To immediately notify prescriber of hy- persensitivity reactions (rash, swelling of face, trouble breathing) • To notify prescriber if pregnancy is planned, suspected
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Extracted information for sitaGLIPtin only.
PHARMACOKINETICS Rapidly absorbed, excreted by the kid- neys (unchanged 79%), half-life 12.4 hr, peak 1-4 hr, duration up to 24 hr
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Filter the extracted dose blocks for this individual drug.
• Adult: PO 100 mg/day; lower dose may be needed when used with a sulfo- nylurea or insulin Renal dose
Candidate age grouping · source page 1212
• Adult: PO CCr 30-50 mL/min, 50 mg daily; CCr <30 mL/min, 25 mg daily
Candidate age grouping · source page 1212