Medications in this category can be recognized by the “-gliptin” ending.
Sitagliptin inhibits an enzyme called dipeptidyl peptidase or DPP-4. By blocking this enzyme, sitagliptin increases the action of incretin hormones that work to stimulate insulin release and to decrease glucagon release after meals. Together, these actions prevent a patient from becoming hyperglycemic.
DPP-4 inactivates incretin hormones. When DPP-4 is blocked by sitagliptin; however, the action of incretin hormones is increased, thus increasing insulin release.
These medications are only effective in the presence of insulin and can only be used in patients with type II diabetes. Keep in mind that DPP-4 inhibitors are considered adjunctive therapy for the treatment of diabetes and should be used in conjunction with metformin, SGLT2 inhibitors, or others.
Although rare, patients may develop pancreatitis. Signs and symptoms of this condition include severe abdominal pain and vomiting. Sitagliptin/saxagliptin therapy should be stopped immediately if these symptoms develop.
Patients taking sitagliptin/saxagliptin may develop an upper respiratory infection or inflammation of the sinuses. Signs and symptoms of a URI include runny or stuffy nose, sneezing, sore throat, and a cough.
Hypersensitivity reactions such as Stevens-Johnsons syndrome, anaphylaxis, and angioedema can occur. Sitagliptin/saxagliptin therapy should be stopped immediately if these conditions develop.
According to the American Diabetes Association, DPP-4 inhibitors are to be used as add-on treatment options. They are indicated if monotherapy has failed to provide adequate blood glucose control.
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