Siltagliptin + Metformin HCI
Initially, 50mg/500mg or 50mg/1000mg twice daily based on dose of metformin already being taken. For patients receiving components as separate tab, switch to equivalent dose. Doses of sulfonylurea or insulin may need to be reduced. Max daily dose of sitagliptin, 100mg.
Moderate to severe renal or hepatic impairment. Diabetic ketoacidosis or pre-coma. Acute conditions predisposing to renal impairment. Cardiac or respiratory failure, recent Ml, acute alcohol intoxication, alcoholism.
Monitor renal function at least annually (2-4 times a year in elderly and patients with serum creatinine levels at ULN). Discontinue for 48 hours before and after surgery and measure renal function before resuming therapy Elderly.
Alcohol cimetidine, iodinated contrast agents, glucocorticoids, ACE inhibitors, potent CY-P3A4 inhibitors, digoxin, insulin, sulfonylureas, diuretics, beta2-agonists.