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Rhinorrhea, cough and fatigue in patients taking sitagliptin.

Baraniuk JN, Jamieson MJ - Allergy Asthma Clin Immunol (2010)

Bottom Line: Similar changes were found in 4 out of 5 persons who had confirmatory readministration.Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome.Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, McMinnville, TN, USA. drmjamieson@gmail.com.

ABSTRACT
Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fisher's Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction.

No MeSH data available.


Related in: MedlinePlus

Demographics, treatments and responses for the sitagliptin intolerant and tolerant groups. Treatments were metformin (Met), sulfonylureas (SU) and insulin. (* Cases 16 and 18 were treated with chronic low dose methotrexate for rheumatoid arthritis. † Case 7 died of a pulmonary embolism, and Case 24 had a sudden unexplained death. n.d., not determined.)
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Figure 1: Demographics, treatments and responses for the sitagliptin intolerant and tolerant groups. Treatments were metformin (Met), sulfonylureas (SU) and insulin. (* Cases 16 and 18 were treated with chronic low dose methotrexate for rheumatoid arthritis. † Case 7 died of a pulmonary embolism, and Case 24 had a sudden unexplained death. n.d., not determined.)

Mentions: Significantly more of the intolerant individuals had allergic rhinitis (15/15) than the sitagliptin tolerant (6/18) group (p = 0.00005). Angiotensin converting enzyme inhibitor (ACEI) intolerance was more common in those intolerant to sitagliptin (6/13) compared to tolerant patients (1/18; p = 0.012). Overall, patients with a clinical history of allergic rhinitis had more ACEI intolerance (7/19) than patients without that history (0/12) (p = 0.019). The two groups were equivalent for age, gender, hemoglobin A1c, the proportions treated with metformin, sulfonylureas and insulin, sitagliptin doses, and rates of improved glucose control and weight loss on sitagliptin (p > 0.20) (Figure 1). These patients were taking multiple medications as is typical for diabetic patients. The most common were ranked as ACE inhibitors, statins, other antihypertensives and antidepressant medications. Their use was similar in both groups. Each patient's combination of medications was evaluated for cytochrome P450 and other drug interactions that could have caused similar patterns of symptoms. However, none were found.


Rhinorrhea, cough and fatigue in patients taking sitagliptin.

Baraniuk JN, Jamieson MJ - Allergy Asthma Clin Immunol (2010)

Demographics, treatments and responses for the sitagliptin intolerant and tolerant groups. Treatments were metformin (Met), sulfonylureas (SU) and insulin. (* Cases 16 and 18 were treated with chronic low dose methotrexate for rheumatoid arthritis. † Case 7 died of a pulmonary embolism, and Case 24 had a sudden unexplained death. n.d., not determined.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2877018&req=5

Figure 1: Demographics, treatments and responses for the sitagliptin intolerant and tolerant groups. Treatments were metformin (Met), sulfonylureas (SU) and insulin. (* Cases 16 and 18 were treated with chronic low dose methotrexate for rheumatoid arthritis. † Case 7 died of a pulmonary embolism, and Case 24 had a sudden unexplained death. n.d., not determined.)
Mentions: Significantly more of the intolerant individuals had allergic rhinitis (15/15) than the sitagliptin tolerant (6/18) group (p = 0.00005). Angiotensin converting enzyme inhibitor (ACEI) intolerance was more common in those intolerant to sitagliptin (6/13) compared to tolerant patients (1/18; p = 0.012). Overall, patients with a clinical history of allergic rhinitis had more ACEI intolerance (7/19) than patients without that history (0/12) (p = 0.019). The two groups were equivalent for age, gender, hemoglobin A1c, the proportions treated with metformin, sulfonylureas and insulin, sitagliptin doses, and rates of improved glucose control and weight loss on sitagliptin (p > 0.20) (Figure 1). These patients were taking multiple medications as is typical for diabetic patients. The most common were ranked as ACE inhibitors, statins, other antihypertensives and antidepressant medications. Their use was similar in both groups. Each patient's combination of medications was evaluated for cytochrome P450 and other drug interactions that could have caused similar patterns of symptoms. However, none were found.

Bottom Line: Similar changes were found in 4 out of 5 persons who had confirmatory readministration.Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome.Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, McMinnville, TN, USA. drmjamieson@gmail.com.

ABSTRACT
Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fisher's Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction.

No MeSH data available.


Related in: MedlinePlus