Januvia (DPP-4 inhibitor) lowers blood-glucose by helping body to make more insulin when needed. In addition, it stops the liver from putting glucose into the blood.
DPP-4 inhibitor or gliptin works by increasing the amount of insulin released by your body and decreasing the amount of sugar made by your body. Dipeptidyl-peptidase 4 inhibitors preferentially target postprandial glucose excursions; however, it also shows to reduce fasting plasma glucose levels.
Dipeptidyl-Peptidase 4 Inhibitors mechanism of action
DPP-4 inhibitors work by increasing incretin levels (GLP-1 and GIP) this inhibits glucagon release, which increases insulin secretion, delay gastric emptying, and decreases blood-glucose levels.
Dipeptidyl-Peptidase 4 Inhibitors diabetes medications
- Generic Name: Linagliptin (Brand Name: Tradjenta)
- Generic Name: Saxagliptin (Brand Name: Onglyza)
- Generic Name: Sitagliptin (Brand Name: Januvia)
- Generic Name: Alogliptin (Brand Name: Nesina)
DPP-4 inhibitor’s dosage
The recommended dose is 5 mg once daily, can be taken with or without food.
Side effects of DPP-4 inhibitors
Long-term side effects of DPP-4 inhibitors on mortality and morbidity are so far inconclusive.
Although adverse effects include:
nasopharyngitis (the common cold),
skin reactions have observed in clinical studies.
What can you expect for DPP-4 inhibitors?
DPP-4 inhibitors can lower your A1C by 0.5 to 1.0%, fasting plasma glucose level by 11 to 22 mg/dL or 0.611 to 1.222 mmol/l, postprandial glucose level by 24 to 35 mg/dL or 1.333 to 1.944 mmol/l. There is no change in lipid, no hypoglycemia, no weight gain. A greater reduction in blood glucose levels is in the case of higher baseline A1C level (i.e., A1C ≥ 9.0%). However, the history of previous, glucose-lowering treatment generally results in a smaller reduction in blood glucose levels.
Who can benefit from DPP-4 inhibitors?
While they do not lower glucose as much compared to existing therapies, they offer many potential advantages. It can achieve sustainable reductions in HbA1c with a low risk of hypoglycemia and no weight gain. It can administer as a once-daily oral dose.
Who should avoid using DPP-4 inhibitors?
Avoid Januvia, if you are pregnant or breast-feeding, having kidney disease, or type 1 with diabetic ketoacidosis.
When compared to sulfonylurea, DPP4 inhibitor is safer with lesser hypoglycemic episodes. However, in combination with other drugs, it has a somewhat higher rate of hypoglycemia. DPP-4 has an association with the immune system; it thought to inhibit it and might impair the immune system. Thus, increase the risk of upper respiratory infection (6.3%) and nasopharyngitis (inflammation of the nose and pharynx in 5.2%).
Primarily, the kidneys break it down and in a small extent by the liver; so the potential for it to interact with other drugs is relatively low. Thus, DPP-4 inhibitors (only in reduced doses) are safe for treating patients with moderate and severe renal failure.
The most worrying side effects are:
allergic reaction causing anaphylaxis,
low blood pressure, and
angioedema, swelling of the tongue, face, and throat.