DPP-4 + biguanide
Sitagliptin with metformin
Brand names: Janumet
Adult dose
Dose: 50/850mg or 50/1000mg PO BD
Route: PO
Frequency: BD
Dose adjustments
Renal
Avoid if eGFR <30; reduce 30–60
Clinical pearls
- T2DM combination per NICE NG28
- Suspend during acute illness/contrast
Contraindications
- Type 1 DM
- DKA
- Severe renal/hepatic impairment
- Hypoxic states
- Pancreatitis history
Side effects
- GI upset
- Pancreatitis
- B12 deficiency
- Lactic acidosis (rare)
- Hypoglycaemia (with sulfonylurea/insulin)
- Hypersensitivity
Interactions
- Iodinated contrast
- Alcohol
- Insulin/sulfonylureas
Monitoring
- HbA1c
- Renal function
- B12
Reference: BNF; NICE NG28; https://bnf.nice.org.uk/drugs/sitagliptin-with-metformin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
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