- 可以使用
- Linagliptin (Trajenta)在腎衰竭病患不用減量
- 其他DPP4i 藥物需減低劑量
Vildagliptin= Galvus
Sitagliptin= Januvia
Saxagliptin= Onglyza
Linagliptin= Trajenta 腎衰竭不用降低劑量
Alogliptin= Vipidia
Stiagliptin + Metformin= Janumet
Vidagliptin + Metformin=Eucreas
Alogliptin + Metformin= Vipdomet
Linagliptin + Metformin= Jentadueto
Saxagliptin + Metformin= Kombolyze
GLIPTINS (DIPEPTIDYL PEPTIDASE 4 INHIBITORS)
Dipeptidyl peptidase 4 (DPP-4) inhibitors (gliptins) constitute a new class of antidiabetic drugs with a very favorable profile: safety, efficacy, and low risk of hypoglycemia and weight neutrality[22].
Gliptin 藥物能抑制 DPP4, DPP4是一種酵素, 可以將很多活性胜肽降解及去活性, 主要是指腸泌素 incretin , 腸泌素包含 GLP-1 及 GDIP, 可刺激胰臟的b細胞分泌胰島素, 腸泌素也會抑制胰臟的昇糖素 glucagon 產生, 腸泌素對於葡萄糖平衡相當重要, 空腹的時候腸泌素分泌下降, 餐後快速分泌, 腸泌素作用結果也會降低昇糖素分泌, 進一步減少肝臟產生的葡萄糖
Gliptins are inhibitors of the enzyme DPP-4. This enzyme degrades and inactivates many active peptides. Among them are incretin hormones. These hormones, namely glucagon like peptide 1 (GLP-1) and glucose dependent insulinotropic polypeptide stimulates glucose dependent insulin secretion by b cells in pancreatic islets. At the same time they suppress glucagon production by a cells in the same islets. Their role in glucose homeostasis seems to be important. These hormones are secreted in low levels when we are fasting but their secretion is rapidly increased after meal consumption. Their action results also in reduced glucagon secretion, which in turns reduces hepatic glucose production.
Vildagliptin, Sitagliptin, Saxagliptin, Linagliptin and Alogliptin belong to this class and are already available in the market. Their place in algorithms for patients with diabetes and CKD is important. We can use them all in CKD but with dose adjustment for the majority of the members of this class. (Only linagliptin does not need dose adjustment in any stage of CKD)[23].
In Table Table22 we summarize the dose adjustments for all gliptins in diabetic subjects with CKD.
效果：中等
低血糖：低
體重：無影響
副作用：少見
心血管實證：中立
• Sitagliptin• Saxagliptin• Vildagliptin • Linagliptin• Alogliptin
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