General Overview

identifying mark Name: Januvia

blanket Name: Januvia Phosphate

Drug level: Dipeptidyl Peptidase-4 (DPP-4) Inhibitor

Manufacturer: Merck & Co., Inc.

Mechanism of activity

The cornerstone of Januvia, Januvia, operates by inhibiting the DPP-4 enzyme, which is accountable for for the degradation of incretin hormones, inclusive of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (hornswoggle). These vital hormones:

– Stimulate insulin exudation from the pancreas in reciprocation to dietary intake.

– Diminish hepatic glucose manufacturing .

By obstructing DPP-4, Januvia amplifies incretin activity, thereby refining glycemic control for individuals grappling with type 2 diabetes.

Uses (Indications)

Management of Type 2 Diabetes Mellitus:

– Enhances glycemic regulation in adults when paired with a balanced diet and physical activity.

– Can be utilized as:

– Monotherapy for patients who cannot tolerate metformin due to contraindications.

– An adjunctive treatment alongside other antidiabetic medications (such as metformin, sulfonylureas, insulin, or SGLT-2 inhibitors).

Dosage and managing

Recommended Dosage:

– Standard Dose: 100 mg once daily, with or without meals.

Dosage accustoming for Renal Impairment:

– Mild Renal Impairment (eGFR ≥ 60 mL/min/1.73 m2): No accustoming  middling .

– commonplace Renal Impairment (eGFR ≥ 30 to< 60 mL/min/1.73 m2): 50 mg once daily.

– terrible Renal Impairment (eGFR< 30 mL/min/1.73 m2) or End-Stage Renal ill health (ESRD): 25 mg once daily.

Administration:

– Can be ingested at any time throughout the day, with no requirement for meal timing adjustments.

Contraindications

– A history of hypersensitivity to sitagliptin or any of its components (e.g., anaphylaxis, angioedema).

– Not suitable for individuals with type 1 diabetes mellitus or diabetic ketoacidosis.

Warnings and Precautions

Pancreatitis:

Instances of acute pancreatitis, both fatal and non-fatal, including hemorrhagic or necrotizing forms, have been documented. Discontinue use if pancreatitis is suspected.

Hypoglycemia:

The risk is low when administered alone but increases when combined with insulin or sulfonylureas.

Renal Function Monitoring:

Evaluate renal function prior to initiation and periodically thereafter. Adjust dosage as necessary for renal impairment.

Hypersensitivity Reactions:

Severe allergic responses, such as Stevens-Johnson syndrome, angioedema, and anaphylaxis, have been reported.

Arthralgia (Joint Pain):

Significant joint pain has been linked to DPP-4 inhibitors, including sitagliptin.

Bullous Pemphigoid:

This rare skin condition necessitates discontinuation of treatment and dermatological intervention.

Side Effects

Common Side Effects:

Symptoms resembling nasopharyngitis (common cold).

Upper respiratory tract infections.

Headaches.

Serious Side Effects:

Acute pancreatitis.

Severe allergic reactions (e.g., anaphylaxis).

Bullous pemphigoid.

Severe joint pain (arthralgia).

Hypoglycemia (when used with insulin or sulfonylureas).

Drug Interactions

Insulin or Sulfonylureas: Heightened risk of hypoglycemia.

Digoxin: A slight increase in digoxin levels (monitor patients receiving digoxin therapy).

No significant interactions with most other common medications.

Special Populations

Pregnancy:

Data is limited; use only if the potential benefits outweigh the risks to the fetus.

Lactation:

It remains uncertain whether sitagliptin is excreted in human milk. Caution is recommended.

Pediatrics:

Safety and efficacy in individuals under 18 years have not been established.

Geriatrics:

No overall differences in safety or effectiveness, but consider the age-related decline in renal function.

Overdose

Symptoms:

May include intensified side effects such as hypoglycemia or gastrointestinal discomfort.

Management:

Eliminate unabsorbed medication through gastric lavage. Provide symptomatic and supportive care. Hemodialysis removes a minor portion of the drug.

Storage

Maintain in a climate-controlled environment, ideally between 20–25C.

Shield from light and humidity.

Ensure it is kept securely away from children.

Patient Counseling

Articulate the significance of strictly following the prescribed dosage and engaging in routine health assessments.

Promptly identify and communicate any signs of pancreatitis or allergic reactions.

Highlight the necessity of a balanced diet, consistent physical activity, and diligent glucose monitoring.

Advise against the consumption of alcohol to prevent the risks of hypoglycemia or pancreatitis.