- Prescribing Advice for GPs - https://www.prescriber.org.uk -

New hypoglycaemic launched

Sitagliptin (Januvia®), the first in a new class of hypoglycaemics has been launched. The Summary of Product Characteristics is available on the Electronic Medicine Compendium.

Sitagliptin is licensed for adjunctive use with metformin or a glitazone in patients with type 2 diabetes to improve glycaemic control. It is available as a 100mg tablet with dosing as a single daily administration. It is the first in a new class of agents called dipeptidyl peptidase 4 (DPP-4) inhibitors which enhance the levels of the incretin hormones naturally secreted after eating food. These hormones act physiologically to increase insulin secretion and decrease glucagon secretion.

As this is a new drug data are limited, however based on research experience:

In clinical studies in 2,700 patients of up to 2 years in duration the most commonly observed side effects included nausea, upper abdominal pain, diarrhoea, somnolence, anorexia, weight loss and hypoglycaemia.

As with all new drugs, initial use should be cautious. This drug is a useful addition to the currently available hypoglycaemics. It may be useful in patients already on metformin who are contraindicated to or suffer intolerable side effects from sulphonylureas or glitazones.

Action: Clinicians should be aware of this new class of drugs. An initially cautious approach to use would place them as last line agents when contraindications or side effects are limiting use of existing therapies.