Januvia
sitagliptin phosphate
Pharmacologic class: Dipeptidyl peptidase 4 (DPP-4) inhibitor
Therapeutic class: Hypoglycemic
Pregnancy risk category B
Action
Inhibits DPP-4 and slows inactivation of incretin hormones, helping to regulate glucose homeostasis through increased insulin release and decreased glucagon levels
Availability
Tablets: 25 mg, 50 mg, 100 mg
Indications and dosages
➣ Adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus
Adults: 100 mg P.O. once daily
Dosage adjustment
• Moderate to severe renal insufficiency or end-stage renal disease
Contraindications
• History of serious hypersensitivity to drug (such as anaphylaxis or angioedema)
Precautions
Use cautiously in:
• concurrent administration of drugs that cause hypoglycemia (such as sulfonylureas or insulin)
• renal impairment, history of pancreatitis
• pregnant or breastfeeding patients
• children younger than age 18 (safety and efficacy not established).
Administration
• Assess renal function before starting therapy.
See Before starting drug, ask patient about possible risk factors for pancreatitis, such as history of pancreatitis, alcoholism, gallstones, or hypertriglyceridemia. However, it's unknown if these conditions make it more likely that pancreatitis will occur.
• Give with or without food.
• Be aware that drug shouldn't be used to treat type 1 diabetes mellitus or diabetic ketoacidosis.
• Know that when drug is used with a sulfonylurea, a lower dose of sulfonylurea may be required, to reduce risk of hypoglycemia.
Adverse reactions
CNS: headache
EENT: nasopharyngitis
GI: abdominal pain, nausea, vomiting, diarrhea, pancreatitis
GU: acute renal failure
Respiratory: upper respiratory tract infection
Other: hypersensitivity reactions (including anaphylaxis, angioedema, exfoliative skin conditions such as Stevens-Johnson syndrome)
Interactions
Drug-drug. Digoxin: minimally increased digoxin effect and blood level
Insulin, sulfonylureas: possible increased hypoglycemia risk
Patient monitoring
• Monitor renal function periodically.
• Measure patient's weight and body mass index periodically during therapy.
• Monitor blood glucose and hemoglobin A1c levels periodically during therapy.
See Monitor patient for signs and symptoms of hypersensitivity reactions and immediately stop drug and institute emergency measures if such reactions occur.
• Check for diabetes signs and symptoms and disease progression routinely during therapy.
See Be aware of postmarketing reports of acute pancreatitis, including fatal and nonfatal hemorrhagic or necrotizing pancreatitis. If pancreatitis is suspected, promptly discontinue drug.
Patient teaching
• Instruct patient to take drug with or without food.
• Teach patient about signs and symptoms of hypoglycemia (such as blurred vision, confusion, tremor, sweating, excessive hunger, drowsiness, and fast heart rate).
See Teach patient about signs and symptoms of hypersensitivity reactions (such as rash, throat swelling, or difficulty breathing) and to immediately contact prescriber if these occur.
See Instruct patient to immediately discontinue drug and report if signs and symptoms of pancreatitis occur (persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting).
• Instruct patient to routinely monitor blood glucose levels at home.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.
sitaGLIPtin
(sit-a-glip-tin) sitagliptin,Januvia
(trade name)Classification
Therapeutic: antidiabeticsPharmacologic: enzyme inhibitors
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | rapid | 1–4 hr | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
Gastrointestinal
- pancreatitis (life-threatening)
- nausea
- diarrhea
Genitourinary
- acute renal failure
Respiratory
- upper respiratory tract infection
- nasopharyngitis
Musculoskeletal
- arthralgia
- back pain
- myalgia
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
- angioedema (life-threatening)
- exfoliative skin conditions (stevens-johnson syndrome) (life-threatening)
- rash
- urticaria
Interactions
Drug-Drug interaction
May slightly ↑ serum digoxin levels; monitoring recommended.↑ risk of hypoglycemia when used with insulin, glyburide, glipizide, or glimepiride (may need to ↓ dose of insulin or sulfonylurea).Route/Dosage
Renal Impairment
Oral (Adults) CCr 30–<50 mL/min—50 mg once daily; CCr <30 mL/min—25 mg once daily.Availability
Nursing implications
Nursing assessment
- Observe patient for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety).
- Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back) during therapy. If pancreatitis occurs, discontinue sitagliptin and monitor serum and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, and lipase.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
- Lab Test Considerations: Monitor hemoglobin A1C prior to and periodically during therapy.
- Monitor renal function prior to and periodically during therapy.
Potential Nursing Diagnoses
Imbalanced nutrition: more than body requirements (Indications)Noncompliance (Patient/Family Teaching)
Implementation
- Do not confuse sitagliptin with sumatriptan. Do not confuse Januvia (sitagliptin) with Enjuvia (estrogens, conjugated B), Jantoven (warfarin), or Janumet (sitagliptin/metformin).
- Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
- Oral: May be administered without regard to food.
Patient/Family Teaching
- Instruct patient to take sitagliptin as directed. Take missed doses as soon as remembered, unless it is almost time for next dose; do not double doses. Advise patient to read Medication Guide before starting and with each Rx refill in case of changes.
- Explain to patient that sitagliptin helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
- Instruct patient not to share this medication with others, even if they have the same symptoms; it may harm them.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
- Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
- Instruct patient in proper testing of blood glucose and urine ketones. These tests should be monitored closely during periods of stress or illness and health care professional notified if significant changes occur.
- Advise patient to stop taking sitagliptin and notify health care professional promptly if symptoms of hypersensitivity reactions (rash; hives; swelling of face, lips, tongue, and throat; difficulty in breathing or swallowing) or pancreatitis occur.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding. Encourage patients who become pregnant while taking sitagliptin to join the pregnancy registry by calling 1-800-986-8999.
Evaluation/Desired Outcomes
- Improved hemoglobin A1C, fasting plasma glucose and 2-hr post-prandial glucose levels.