DPP-4 Inhibitor Pregnancy: Should not be used during pregnancy — there are no adequate data in pregnant women and animal studies have shown reproductive toxicity at high doses; the potential risk for humans is unknown. Should not be used during breast-feeding (excretion in human milk unknown; excreted in animal milk).

Sitagliptin

Brand names: Januvia, Xelevia

Used in: Diabetes & DKA

Sitagliptin is a DPP-4 inhibitor (a gliptin) used in type 2 diabetes; it is weight-neutral and carries a low risk of hypoglycaemia when used alone.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 100 mg sitagliptin once daily

Route: Oral

Frequency: Once daily, with or without food

UK SPC (Sitagliptin 100 mg film coated tablets). When used in combination with metformin and/or a PPAR-gamma agonist, the dose of metformin and/or PPAR-gamma agonist should be maintained and sitagliptin administered concomitantly. When used with a sulphonylurea or with insulin, a lower dose of the sulphonylurea or insulin may be considered to reduce the risk of hypoglycaemia. Missed dose: take as soon as the patient remembers; a double dose should not be taken on the same day. Hepatic impairment: no dose adjustment for mild to moderate impairment; not studied in severe hepatic impairment — care should be exercised. Elderly: no dose adjustment based on age. Paediatric population: should not be used in children and adolescents 10 to 17 years of age because of insufficient efficacy; has not been studied in patients under 10 years of age. Should not be used in type 1 diabetes or for the treatment of diabetic ketoacidosis. Assessment of renal function is recommended prior to initiation and periodically thereafter. SOURCE GAP: section 4.5 (interactions) was truncated in the fetched bundle — clinician to check the full SPC for interaction data.

Dose adjustments

Renal

Mild impairment (GFR 60 to under 90 mL/min): no dose adjustment. Moderate impairment (GFR 45 to under 60 mL/min): no dose adjustment. Moderate impairment (GFR 30 to under 45 mL/min): 50 mg once daily. Severe impairment (GFR 15 to under 30 mL/min) or end-stage renal disease (GFR under 15 mL/min), including haemodialysis or peritoneal dialysis: 25 mg once daily — may be administered without regard to the timing of dialysis.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Hypoglycaemia (common; reported in combination with sulphonylurea 4.7%-13.8% and insulin 9.6%)
Headache (common); dizziness (uncommon)
Constipation, pruritus (uncommon)
Acute pancreatitis, including fatal and non-fatal haemorrhagic and necrotising pancreatitis (frequency not known)
Hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria and exfoliative skin conditions including Stevens-Johnson syndrome (frequency not known); bullous pemphigoid (frequency not known)
Thrombocytopenia (rare); impaired renal function and acute renal failure (frequency not known)

Interactions

Sulphonylureas — hypoglycaemia observed in combination; a lower dose of the sulphonylurea may be considered (from sections 4.2 and 4.4; section 4.5 was not captured in the fetched bundle)
Insulin — hypoglycaemia observed in combination; a lower dose of insulin may be considered
Metformin and/or PPAR-gamma agonists — dose of the co-administered agent should be maintained; rates of hypoglycaemia were similar to placebo with these combinations

Clinical monograph

How it works

It inhibits dipeptidyl peptidase-4, prolonging the action of incretin hormones to enhance glucose-dependent insulin release and suppress glucagon.

Prescribing in practice

Reduce the dose in renal impairment.
Hypoglycaemia risk is low alone but rises when combined with a sulfonylurea or insulin.
Stop and investigate if severe, persistent abdominal pain suggests pancreatitis.

Monitoring

Monitor HbA1c for response and renal function for dose adjustment.

Counselling the patient

It is generally well tolerated and does not usually cause low blood sugar on its own.
Report severe, persistent abdominal pain.

Evidence & guidelines

DPP-4 inhibitors are an option to intensify type 2 diabetes treatment per NICE NG28, valued for weight-neutrality and low hypoglycaemia risk.

Reference: NICE NG28; TECOS trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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