Vilantra Special Precautions

General: Sitagliptin (Vilantra) should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.
Acute pancreatitis: Use of DPP-4 inhibitors has been associated with a risk of developing acute pancreatitis. Patients should be informed of the characteristic symptom of acute pancreatitis: persistent, severe abdominal pain. Resolution of pancreatitis has been observed after discontinuation of Sitagliptin (with or without supportive treatment), but very rare cases of necrotising or haemorrhagic pancreatitis and/or death have been reported. If pancreatitis is suspected, Sitagliptin (Vilantra) and other potentially suspect medicinal products should be discontinued; if acute pancreatitis is confirmed, Sitagliptin (Vilantra) should not be restarted. Caution should be exercised in patients with a history of pancreatitis.
Hypoglycaemia when used in combination with other anti-hyperglycaemic medicinal products: In clinical trials of Sitagliptin (Vilantra) as monotherapy and as part of combination therapy with medicinal products not known to cause hypoglycaemia (i.e. metformin and/or a PPARγ agonist), rates of hypoglycaemia reported with Sitagliptin were similar to rates in patients taking placebo.
Hypoglycaemia has been observed when Sitagliptin was used in combination with insulin or a sulphonylurea. Therefore, to reduce the risk of hypoglycaemia, a lower dose of sulphonylurea or insulin may be considered.
Renal impairment: Sitagliptin is renally excreted. To achieve plasma concentrations of Sitagliptin similar to those in patients with normal renal function, lower dosages are recommended in patients with moderate and severe renal impairment, as well as in ESRD patients requiring haemodialysis or peritoneal dialysis.
When considering the use of Sitagliptin in combination with another antidiabetic medicinal product, its conditions for use in patients with renal impairment should be checked.
Hypersensitivity reactions: Post-marketing reports of serious hypersensitivity reactions in patients treated with Sitagliptin have been reported. These reactions include anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. Onset of these reactions occurred within the first 3 months after initiation of treatment, with some reports occurring after the first dose. If a hypersensitivity reaction is suspected, Sitagliptin (Vilantra) should be discontinued. Other potential causes for the event should be assessed, and alternative treatment for diabetes initiated.