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    Compare Gliflozin Gliptin

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    Rudren Eswaran Krishnan
    The document compares the mechanisms of action, indications, dosing, administration, and safety profiles of SGLT2 inhibitors and DPP-4 inhibitors for treating type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine while DPP-4 inhibitors work by increasing insulin secretion and decreasing glucagon secretion. Key differences between the classes include SGLT2 inhibitors causing weight loss and increasing LDL cholesterol and fracture risk, while DPP-4 inhibitors carry a neutral risk profile.

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    Compare Gliflozin Gliptin

    Uploaded by

    Rudren Eswaran Krishnan
    114 views3 pages
    The document compares the mechanisms of action, indications, dosing, administration, and safety profiles of SGLT2 inhibitors and DPP-4 inhibitors for treating type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine while DPP-4 inhibitors work by increasing insulin secretion and decreasing glucagon secretion. Key differences between the classes include SGLT2 inhibitors causing weight loss and increasing LDL cholesterol and fracture risk, while DPP-4 inhibitors carry a neutral risk profile.

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    The document compares the mechanisms of action, indications, dosing, administration, and safety profiles of SGLT2 inhibitors and DPP-4 inhibitors for treating type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine while DPP-4 inhibitors work by increasing insulin secretion and decreasing glucagon secretion. Key differences between the classes include SGLT2 inhibitors causing weight loss and increasing LDL cholesterol and fracture risk, while DPP-4 inhibitors carry a neutral risk profile.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    114 views3 pages

    Compare Gliflozin Gliptin

    Uploaded by

    Rudren Eswaran Krishnan
    The document compares the mechanisms of action, indications, dosing, administration, and safety profiles of SGLT2 inhibitors and DPP-4 inhibitors for treating type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine while DPP-4 inhibitors work by increasing insulin secretion and decreasing glucagon secretion. Key differences between the classes include SGLT2 inhibitors causing weight loss and increasing LDL cholesterol and fracture risk, while DPP-4 inhibitors carry a neutral risk profile.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Comparison table

    Drug class Sodium-glucose co-transporter 2 (SGLT2) inhibitors Dipeptidyl peptidase-4 (DPP-4) inhibitors
    Mechanism of Increase urinary excretion of glucose Increase glucose-dependent insulin
    action secretion
    Decrease glucagon secretion
    Drugs Dapagliflozin Sitagliptin; Linagliptin
    Indication as dual therapy Adjunct to diet and exercise to improve
    o in combination with metformin for patients with glycemic control in adults with type 2
    HbA1c measurement greater than 7% despite diabetes mellitus as
    treatment with metformin monotherapy and monotherapy
    when sulfonylureas are contraindicated or not add on to metformin
    tolerated or the person is at significant risk of add on to sulphonylurea
    hypoglycaemia or its consequences; or add on to insulin (with or without
    o in combination with a sulfonylurea for patients metformin) add on to metformin plus
    with HbA1c measurement greater than 7% despite sulphonylurea
    treatment with sulfonylurea monotherapy and
    when metformin is contraindicated or not
    tolerated; or
    as a triple therapy
    o in combination with metformin and a
    sulfonylurea for patients with HbA1c
    measurement greater than 7% despite treatment
    with optimal doses of dual therapy.
    as monotherapy (not approved MAF use criteria)
    o only for patients with HbA1c measurement
    greater than 7% despite lifestyle measure and
    where the use of metformin and sulphonylureas is
    contraindicated or not tolerated.
    as combination therapy with insulin
    o in combination with insulin with or without other
    anti-diabetic drugs for patients with HbA1c
    measurement greater than 7% despite treatment
    with optimal doses of other anti-diabetic drugs

    Adult dose Initiate at 5mg and titrate as needed to 10mg once daily Sitagliptin : Up to 100mg once daily
    For patients at risk for volume depletion due to co-existing Linagliptin 5mg once daily
    conditions, a 5 mg starting dose may be appropriate
    Administration Taken once daily without regard to meals Taken once daily without regard to meals
    Dose adjustment: Assess kidney function prior to starting dapagliflozin and Sitagliptin
    Renal impairment monitor periodically thereafter. CrCl 50 mL/minute: No dosage
    CrCl or eGFR 60 mL/minute/1.73 m2: No dosage adjustment necessary. 100 mg once
    adjustment necessary. daily
    CrCl or eGFR 30 to <60 mL/minute/1.73 m2: Use is not CrCl 30 to <50 mL/minute
    recommended for initiation of therapy or when eGFR is (approximate SCr of >1.7 to 3 mg/dL
    persistently between 30 and <60 mL/minute/1.73 m2. [males] or >1.5 to 2.5 mg/dL
    CrCl or eGFR <30 mL/minute/1.73 m2: Use is [females]): 50 mg once daily
    contraindicated. CrCl <30 mL/minute (approximate SCr
    ESRD: Use is contraindicated. of >3 mg/dL [males] or >2.5 mg/dL
    Hemodialysis: Use is contraindicated. [females]): 25 mg once daily
    ESRD requiring hemodialysis or
    peritoneal dialysis: 25 mg once daily;
    administer without regard to timing
    of hemodialysis

    Linagliptin: No dosage adjustment


    necessary.
    Drug class Sodium-glucose co-transporter 2 (SGLT2) inhibitors Dipeptidyl peptidase-4 (DPP-4) inhibitors
    Dose adjustment: Mild to moderate hepatic impairment: No dosage adjustment Sitagliptin
    Hepatic impairment necessary Mild to moderate impairment
    Severe hepatic impairment: Should not be used (no (Child-Pugh classes A and B): No
    information) dosage adjustment necessary.
    Severe impairment (Child-Pugh
    class C): use has not been studied

    Linagliptin: No dosage adjustment


    necessary.
    Cost Sitagliptin (Januvia)
    Dapagliflozin (Forxiga) 100mg tablet $ 2.57/tablet
    10mg tablet $1.36/tablet 50mg tablet $ 2.57/tablet

    Linagliptin (Trajenta)
    5mg tablet $ 1.71/tablet

    Contraindication -History of serious hypersensitivity to dapagliflozin or any Hypersensitivity to the active ingredient
    component of the formulation or any of the excipients
    -Renal impairment (eGFR <60 mL/minute/1.73 m2)
    -End-stage renal disease (ESRD), or patients on dialysis
    -Restarting SGLT2 inhibitor treatment in patients with previous
    diabetic ketoacidosis (DKA) while on SGLT2 inhibitor treatment
    is not recommended (unless another clear precipitating factor
    was identified and resolved)
    -Not recommended for use in patients receiving loop diuretics
    or who are volume depleted due to acute illness

    Cautions Caution should be exercised in patients for whom a


    dapagliflozin-induced drop in blood pressure could pose a risk,
    such as patients with known cardiovascular disease, renal
    impairment, patients on anti-hypertensive therapy with a
    history of hypotension or elderly patients
    Fasting plasma Moderate Mild
    glucose lowering
    Postprandial glucose Mild Moderate
    lowering
    Hypoglycemia risk Neutral Neutral
    Weight Loss Neutral
    Genitourinary May increase the risk of genital mycotic infections Nil
    Cardiac Possible CV benefit (evidence for empagliflozin, unknown if Neutral (possible risk for saxagliptin)
    other SGLT2 inhibitors will have similar CVD effects) Unclear if the risk is specific to certain
    May increase LDL DPP-4 inhibitors and whether it extends
    Blood pressure reduction to patients without CVD.
    Bone May increase risk of bone fractures (Warning for canagliflozin) Neutral
    Ketoacidosis Risk of DKA in stress settings Neutral
    Arthralgia Nil Severe and disabling arthralgia has been
    reported with DPP-IV inhibitor use; onset
    may occur within one day to years after
    treatment initiation and may resolve with
    discontinuation of therapy. Some patients
    may experience a recurrence of
    symptoms if DPP-IV inhibitor therapy
    resumed
    Pancreatitis Nil Cases of acute pancreatitis, including
    fatalities, have been reported with use
    Prepared by Dr Nor Izuan on 17 April 2017

    Reviewed by Tan Beng Li, NHG Pharmacy, Drug Information Service, 21 April 2017

    References used
    Lexicomp Drug Information: Dapagliflozin, Sitagliptin, Linagliptin
    Product inserts: Forxiga, Januvia, Trajenta
    American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for
    Developing a Diabetes Mellitus Comprehensive Care Plan. ENDOCRINE PRACTICE Vol 21 No. 4 April 2015

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