Nesina Disease Interactions

There have been postmarketing reports of acute pancreatitis in patients taking DPP-4 inhibitors. These drugs should be used with caution in patients with a history of pancreatitis or pancreatic disease, although it is unknown if they are at increased risk. Patients should be observed for signs and symptoms of pancreatitis during treatment. If pancreatitis is suspected, treatment should be discontinued immediately and appropriate management should be initiated.

There have been postmarketing reports of hepatic failure (fatal and non-fatal) in patients taking alogliptin. Treatment should be started with caution in patients with preexisting liver disease. It is recommended to assess the liver function of the patient before starting therapy. If liver test abnormalities worsen without explanation during treatment, therapy should be discontinued and the cause of the abnormalities should be studied.

It is recommended to assess renal function prior to initiating treatment with DPP-4 inhibitors. Patients with moderate to severe renal insufficiency and end stage renal dysfunction will require a dose adjustment. Linagliptin will not require a dose adjustment per manufacturer's information. Additionally, there have been postmarketing reports of worsening renal function in some patients with renal insufficiency taking sitagliptin at inappropriate doses. However, sitagliptin has not been found to be nephrotoxic in preclinical studies or clinical trials at appropriate doses.