Dr. James Sharkoff explains Dipeptidyl Peptidase 4 (DDP 4 Inhibitors) and how they treat Type II Diabetes.
Welcome to physician academy today we’re going to talk about dpp-4 inhibitors also known as glib tins or die pep till little peptidase-4 inhibitors now you know why they call them dpp-4 inhibitors they’re called lipton’s because all the medications have flipped them in their name so sit too glib didn’t saxagliptin and then i lipton are the common ones and we’ll
Go over there those as we get to them the dpp-4 inhibitors reduce glucagon and blood glucose levels dpp-4 inhibitors increase increasing levels the glp-1 and gip which inhibit glucagon release in turn this increases insulin secretion decreases gastric tempting and decreases blood glucose levels all wonderful things in our type 2 diabetics the adverse effects the
Adverse effects including are for this medication or is the neuro pharyngitis headaches nausea heart failure hypersensitivity and skin reactions they also may get joint pain and for those who are taking sulfonylureas there’s also an increased risk for low blood sugar so as with all the newer medications as we use them more and more in our patients we’re learning
More information so a couple issues that have showed up with the dpp-4 is the question of cosmic mortalities and heart failure as well as pancreatitis or pancreatic cancer and other issues so in 2014 there was a meta-analysis that found no favorable or harmful effect of dpp-4 inhibitors on all-cause mortality cardiovascular mortality or stroke but a marginally
Statistically significant increase in heart failure so you need to be aware that you may increase the heart failure in the patients will discuss heart failure obviously in another lecture a 2014 meta-analysis also found no evidence for increased pancreatic cancer risk in people treated with the dpp-4 inhibitors the in 2014 there was another review found increased
Risk of heart failure with saxagliptin and a logue lipton prompting the fda in 2016 to add warnings to the relevant drug labels what are the common drugs that are out there there’s ciktin lipton also known as januvia which is one of the ones i use a lot saxagliptin onglyza and linagliptin try jente alogliptin is necia so we start ciktik sittig lipton it comes in
A 25 50 and a 100 milligram pill and we started at 50 milligrams daily more commonly it’s going to be at 100 milligrams daily but it’s nice to start at a lower dose monitor the patient see what’s going to happen with the patient and see how they respond to the medication saxagliptin comes in a 2.5 and a 5 milligram so we usually start that one at 2.5 daily with
A max of five milligrams daily this one is cleared seventy-five percent in the urine and twenty-two percent in the feces linagliptin is a fight comes as a 5 milligram daily tablet so it started once a day five milligrams and that’s cleared eighty percent in the feces in five percent in the urine the a load lipton comes as a 25 milligram only and it started as 25
Milligrams once a day the nice thing is there are combination pills there januvia comes as a combination janu vomit that’s sit too glib de nin metformin together and that works really well so you can give it as a combination pill and there’s less pills for the patient to take so how should you monitor the patient and when you decide to change therapies the common
Monitoring would be again the same thing as for most of the medications which is a complete metabolic panel and a hemoglobin a1c and you check that at the beginning of therapy and then every three months monitor the nollan turing the patients and adjusting the treatment as needed you
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Physician.Academy- Treating Type II Diabetes: Dipeptidyl Peptidase 4 By Physician.Academy
