Drug Interactions of Antidiabetics (Part 8):

Drug Interactions of DPP 4 Inhibitors:

§  Dipeptidyl peptidase 4 (DPP 4) inhibitors like Sitagliptin, Vildagliptin, Saxagliptin and  Linagliptin can prevent the degradation of Glucagon Like Peptide 1 (GLP 1) by inhibiting the enzyme Dipeptidyl peptidase 4 (DPP 4).

§  Prevention of degradation of Glucagon Like Peptide 1 (GLP 1) results in to increased GLP 1 levels which inhibit the Glucagon release leading to increased insulin secretion, decreased gastric emptying, and decreased blood glucose levels.

§  Concomitant use of DPP4 inhibitors and P-glycoprotein inhibitors such as Tocofersolan, Nilotinib and Lomitapide may result into increased plasma levels of DPP4 inhibitors due to the inhibition of P-glycoprotein-mediated efflux transport of DPP4 inhibitors.

§  The plasma levels of DPP4 inhibitors also increased by CYP3A4 inhibitors such as Piperaquine and Amiodarone.

§  CYP3A4 inducers like Dabrafenib, Eslicarbazepine and Primidone may decrease the plasma levels of DPP4 inhibitors.

§  The risk of hyperglycemia may be increased by Danazol and Trandolapril.

§  The plasma concentrations of saxagliptin may be increased by CYP3A4 inhibitors like Cobicistat, Azole antifungals (Posaconazole, Itraconazole & Ketoconazole), Antivirals (Indinavir, Nelfinavir, Saquinavir & Ritonavir) and Macrolide antibiotics (Telithromycin and Clarithromycin).

§  The plasma levels of Linagliptin may be decreased by CYP3A4 inducers like Rifampin, Phenytoin, Phenobarbital, Carbamazepine and St John's wort.

§  The blood sugar level should be monitored and dosage of antidiabetics may be adjusted if necessary, to avoid complications from above said interactions.

§  The diabetics should bring a list of all of the drugs they are taking, including prescription drugs, over-the-counter drugs, and any supplements, herbal products, etc. during their visit to the doctor or pharmacist, to minimize the possibility of potentially dangerous combinations.