DPP-4 Inhibitor
Pregnancy: B
Sitagliptin
Brand names: Januvia, Xelevia
Adult dose
Dose: 100mg once daily
Route: Oral
Frequency: Once daily
Renal dose: eGFR 30–45 → 50mg OD; eGFR 15–30 → 25mg OD; eGFR <15/dialysis → 25mg OD.
Clinical pearls
- Weight-neutral — advantage over sulfonylureas and insulin
- Low hypoglycaemia risk when used as monotherapy
- Renal dose reduction required — unlike SGLT2 inhibitors
- Discontinue if pancreatitis suspected
- TECOS trial: no cardiovascular benefit or harm — CV-neutral
Contraindications
- Type 1 diabetes
- DKA
Side effects
- Nasopharyngitis
- URTI
- Pancreatitis (rare)
- Arthralgia
- Severe joint pain (class effect)
Interactions
- Digoxin — slight increase in digoxin levels (monitor)
- CYP3A4/2C8 inducers (rifampicin) — may reduce efficacy
Monitoring
- HbA1c (3–6 monthly)
- eGFR (before starting, then annually)
- Lipase if abdominal symptoms
Reference: NICE NG28; TECOS trial. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016