As a pharmacy doctor, DON'T forget to ask about side effects. New warnings from experts will spur questions about whether gliptins (Januvia, Onglyza, Galvus, etc) cause severe joint pain. This risk seems to be a class effect of gliptins, and it's very rare, but the pain can be disabling.
We know these diabetes medications inhibit dipeptidyl peptidase-4 (DPP-4), an enzyme that breaks down incretin hormones. But inhibiting DPP-4 MIGHT also lead to inflammation.
Listen for complaints of severe, persistent joint pain in gliptin patients. Symptoms often occur within a month, but can happen at any time. Also, consider other causes, such as muscle pain due to a statin.
If joint pain is thought to be from a gliptin, recommend stopping it. Explain that symptoms usually go away within a month. Don't rely on switching to a different gliptin, it may not prevent a recurrence. Add this concern to your list of gliptin downsides, they only lower A1C by about 0.5%, some may be linked to heart failure (saxagliptin), etc. Continue to recommend saving gliptins as a metformin add-on for certain diabetes patients close to their A1C goal. FOR MORE INFORMATION, GET OUR NOTE "Precautions or contraindications for the use of antidiabetic drugs".
REFERENCES
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Crickx E, Marroun I, Veyrie C, Le Beller C, Schoindre Y, Bouilloud F, Blétry O, Kahn JE. DPP4 inhibitor-induced polyarthritis: a report of three cases. Rheumatol Int. 2014 Feb;34(2):291-2. doi: 10.1007/s00296-013-2710-7. Available at: https://pubmed.ncbi.nlm.nih.gov/23462883
FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-dpp-4-inhibitors-type-2-diabetes-may-cause-severe-joint-pain
Saito T, Ohnuma K, Suzuki H, Dang NH, Hatano R, Ninomiya H, Morimoto C. Polyarthropathy in type 2 diabetes patients treated with DPP4 inhibitors. Diabetes Res Clin Pract. 2013 Oct;102(1):e8-e12. Available at: https://pubmed.ncbi.nlm.nih.gov/23937822