Sitagliptin DPP-4 inhibitor Renal function: GI problems Take with or without food Pancreatitis symptoms – (100mg a day) inhibits DPP-4 Reduce dose to 50mg od if Nasopharyngitis Hypo unlikely if used on its include persistent, severe enzyme resulting eGFR 30-50 ml/min/1.73m² Pancreatitis own abdominal pain in increased Reduce dose to 25mg od if Rash Weight neutral availability of eGFR < 30 ml/min/1.73m² incretin hormones which stimulate insulin secretion Linagliptin Same as No dose adjustment Cough Same as sitagliptin Same as sitagliptin (5mg a day) sitagliptin needed in renal and Nasopharyngitis hepatic impairment Pancreatitis Alogliptin Same as Renal function: GI problems Same as sitagliptin Same as sitagliptin (25mg a day) sitagliptin Reduce dose to 12.5mg od Nasopharyngitis Not licensed for if eGFR Pancreatitis monotherapy Rash Reduce dose to 6.25mg if eGFR < 30 ml/min/1.73m² Avoid in severe hepatic impairment Dapagliflozin SGLT-2 inhibitor Renal function: GI problems Take with or without food MHRA advice on risk of DKA – (10mg a day; reversibly inhibits Avoid if eGFR Thirst Hypo unlikely if used on its DKA symptoms: N&V, initiation not SGLT-2 in <60ml/min/1.73m² Polyuria own abdominal pain, sleepiness, a recommended proximal Hepatic function: Increased risk of genital sweet smell to the breath in convoluted Initial dose 5mg a day in infections Possible wt loss ≥ tubule to reduce severe impairment, UTI glucose increase according to Low BP reabsorption and response Volume depletion increase urinary Risk of DKA glucose excretion
Sitagliptin (100mg a day) DPP-4 inhibitor – inhibits DPP-4 enzyme resulting in increased availability of incretin hormones which stimulate insulin secretion Renal function: Reduce dose to 50mg od if eGFR 30-50 ml/min/1.73m² Reduce dose to 25mg od if eGFR < 30 ml/min/1.73m² GI problems Nasopharyngitis Pancreatitis Rash Take with or without food Hypo unlikely if used on its own Pancreatitis symptoms include persistent, severe abdominal pain Weight neutral Linagliptin (5mg a day) Same as sitagliptin No dose adjustment needed in renal and hepatic impairment Cough Nasopharyngitis Pancreatitis Same as sitagliptin Same as sitagliptin Alogliptin (25mg a day) Same as sitagliptin Renal function: Reduce dose to 12.5mg od if eGFR Reduce dose to 6.25mg if eGFR < 30 ml/min/1.73m² Avoid in severe hepatic impairment GI problems Nasopharyngitis Pancreatitis Rash Same as sitagliptin Same as sitagliptin Not licensed for monotherapy Dapagliflozin (10mg a day; initiation not recommended in ≥ SGLT-2 inhibitor – reversibly inhibits SGLT-2 in proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion Renal function: Avoid if eGFR <60ml/min/1.73m² Hepatic function: Initial dose 5mg a day in severe impairment, increase according to response GI problems Thirst Polyuria Increased risk of genital infections UTI Low BP Volume depletion Risk of DKA Take with or without food Hypo unlikely if used on its own MHRA advice on risk of DKA DKA symptoms: N&V, abdominal pain, sleepiness, a sweet smell to the breath Possible wt loss
Anti-diabetic-drugs-and-statins-NMS-and-MUR.docx