rhinorrhea, cough and fatigue in patients taking sitagliptin鼻涕、咳嗽病人服用sitagliptin和疲劳.pdfVIP

Baraniuk and Jamieson Allergy, Asthma Clinical Immunology 2010, 6:8 /content/6/1/8 ALLERGY, ASTHMA CLINICAL IMMUNOLOGY R E S E A R C H Open Access Research Rhinorrhea, cough and fatigue in patients taking sitagliptin 1 2 James N Baraniuk and Mary J Jamieson* Abstract Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fishers Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction. Background gliptin induced a reproducible syndrome. Whe