Sitagliptin and Simvastatin (Oral)

Traditionally, simvastatin and sitagliptin were administered as two separate medications, but a single-dose variant (marketed by Merck as Juvisync) was approved in 2011.

Overview

Sitagliptin and simvastatin is a combination drug used, alongside a healthy diet and regular exercise, in the treatment of Type 2 diabetes and hypercholesterolemia (high levels of cholesterol and triglycerides in the blood), in those circumstances when they present at the same time in the same patient.

Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor, commonly used in the treatment of Type 2 diabetes. It works by promoting increased levels of insulin production in the pancreas, whilst simultaneously sending a signal to the patient’s liver to inhibit the production of glucose (sugar) in the blood.

Simvastatin is part of the statin family of medications and acts as an HMG-CoA reductase inhibitor. It works by inhibiting the production of cholesterol in the body, thus reducing the presence of cholesterol in a patient’s blood.

As well as its primary application in the treatment of Type 2 diabetes and hypercholesterolemia, sitagliptin and simvastatin might also be implemented to prevent certain medical conditions that are instigated by clogging of the arteries and blood vessels. This includes such ailments as strokes and heart attacks.

Traditionally, the two drugs were administered as separate medicines, but a single dose variant (marketed by Merck as Juvisync) was approved for sale in 2011, though the company ceased marketing the product since 26 September 2013, at least in the United States.

Juvisync was only ever available with a doctor’s prescription.

Sitagliptin and simvastatin is available in the following dosage forms:

  • Tablet

Conditions Treated

  • Type 2 diabetes
  • Hypercholesterolemia (high levels of cholesterol and triglycerides in the blood)

Type of Medicine

  • HMG-CoA reductase inhibitor
  • DPP-4 (dipeptidyl peptidase-4) inhibitor

Side Effects

Alongside its expected and desired effects, any medication might result in some less desirable effects. Whilst there is no guarantee that all of the side effects (or any of them) might occur, should any of them do so you may require medical attention.

Should any of these side effects listed exhibit themselves during your course of treatment with Sitagliptin and simvastatin, you should immediately consult your prescribing doctor.

  • Anxiety
  • Yellow skin or eyes
  • Weakness to the feet, legs, hands, or arms
  • Vomiting
  • Unusual weakness or tiredness
  • Unusual bruising or bleeding
  • Awkwardness or unsteadiness
  • Unexplained loss of weight
  • Troubled breathing
  • Tightness of the chest
  • Swollen joints
  • Swollen glands
  • Swelling
  • Sweating
  • Stomachache
  • Blisters, welts, or sores no the skin
  • White spots, ulcers, or sores around the mouth, or upon the lips
  • Sore throat
  • Slurred speech
  • Skin rash
  • Shakiness
  • Severe sunburn
  • Seizures
  • Redness to the upper chest, arms, neck and face
  • Itching, sore, or red skin
  • Irritated, red eyes
  • Red lesions on the skin, frequently with purple centers
  • Rapid gain of weight
  • Red pinpoint spots to the skin
  • Pains to the abdomen, side, or stomach, occasionally radiating around to the patient’s back
  • Nightmares
  • Nausea
  • Muscle weakness, wasting, tenderness, or pain
  • Muscle spasms or cramps
  • Side or lower back pain
  • Lack of consciousness
  • Lack of appetite
  • Lethargy
  • Large swellings, like hives, to the sex organs, feet, legs, hands, throat, tongue, lips, eyelids, or face
  • Muscle or joint pain
  • Irritability
  • Indigestion
  • Increased urination
  • Increased thirst
  • Increased sensitivity to the skin under sunlight
  • Increased hunger
  • Hives
  • Headache
  • Fruit-like odor on the breath
  • Frequent need to urinate
  • Dry, flushed skin
  • Fever
  • Feelings of warmth
  • Irregular or fast heartbeat
  • Fainting
  • Dry mouth
  • Dizziness
  • Difficulty when swallowing
  • Difficulty when moving
  • Painful, burning, or difficult urination
  • Diarrhea
  • Depression
  • Decrease in urine output
  • Dark-colored urine
  • Pale, cool skin
  • Constipation
  • Confusion
  • Cold sweats
  • Chills
  • Chest pain
  • Tingling, pins and needles, prickling, numbness, itching, crawling, or burning feelings
  • Blurred vision
  • Cloudy or bloody urine
  • Bloating
  • Loosening, peeling, or blistering of the skin
  • Bleeding gums
  • Bladder pain
  • Tarry, black stools
  • Agitation

The effects listed above might require the attention of a medical expert. However, other side effects might also present themselves, which do not require medical attention. Many of these effects should disappear throughout your course of treatment, while your body becomes acclimatized to the medication. Additionally, your prescribing doctor might be able to recommend a way to reduce or prevent all (or at least some) of the potential negative effects. Should any of the side effects listed below continue throughout your course of treatment, or should they become bothersome to you, you ought to consult your doctor.

  • Body pain or aches
  • Trouble whilst sleeping
  • Thinning hair
  • Tenderness to the stomach
  • Stomach pain, upset, or discomfort
  • Sneezing
  • Rash on the skin that becomes oozing, scaly, and encrusted
  • Feeling of spinning
  • Stuffy or runny nose
  • Issues with memory
  • Passing gas
  • Tenderness or pain around the cheekbones and eyes
  • Lack of voice
  • Loss of sexual performance, drive, desire, or ability
  • Inability to attain or maintain an erection
  • Heartburn
  • Hair loss
  • Full feeling
  • Sensation of persistent movement of oneself or surroundings
  • Excess gas or air in the intestines or stomach
  • Ear congestion
  • Light-headedness or dizziness
  • Decrease of interest regarding sexual intercourse
  • Cough that creates mucus
  • Burning feeling in the stomach or chest
  • Belching
  • Being forgetful
  • Sour or acid stomach

The effects listed above are not exhaustive, and there might be other negative impacts that present themselves as a result of taking Sitagliptin and simvastatin. If you become aware of any negative effects during your course of treatment with Sitagliptin and simvastatin, be sure to speak with your doctor.

Dosage

The dosage recommended of Sitagliptin and simvastatin differs from one patient to the next. You must always follow the directions of your prescribing doctor or the instructions printed on your medication’s label. The information listed below indicates the average dosages of Sitagliptin and simvastatin, and should not be taken as medical advice. Should your doctor prescribe a dosage that differs from those listed here, you must not alter them unless explicitly advised to by your examining doctor.

The amount of Sitagliptin and simvastatin you take will depend upon how strong the medicine is. Additionally, the time you should allow to elapse between doses, the amount of doses that you take every day, and how long your course of Sitagliptin and simvastatin will last depends entirely upon the nature of the medical condition for which it has been prescribed.

For oral dosage tablets:

For Type 2 diabetes and high cholesterol:

For patients not already taking either simvastatin or sitagliptin:

  • Adults – initially, 100 milligrams (mg) of sitagliptin, together with 40 mg of simvastatin, once per day, of an evening. Your prescribing doctor might choose to amend your dosage as required.
  • Children: the use and dosage of Sitagliptin and simvastatin must be decided upon by your prescribing doctor.

For patients already taking simvastatin:

  • Adults – initially, 100 milligrams (mg) of sitagliptin, together with your current dosage of simvastatin, once per day, of an evening. Your prescribing doctor might choose to amend your dosage as required.
  • Children: the use and dosage of Sitagliptin and simvastatin must be decided upon by your prescribing doctor.

If you happen to miss a dosage of Sitagliptin and simvastatin, you should take it at the earliest opportunity. However, should it be nearly time for the next dosage, you ought to skip your missed dosage and return to your normal schedule of dosing. Under no circumstances should you double the dose.

Interactions

Whilst there are some medications that ought never be utilized alongside one another, in any event, there might be other circumstances where a pair of different drugs can be taken concurrently, even though an interaction is known likely to occur. In such a situation, your prescribing doctor might choose to amend your dosage, or could recommend further precautions. Whilst taking Sitagliptin and simvastatin, it is essential that your examining doctor is aware that you take any other medication, particularly the ones that are listed beneath. These interactions are listed here based on the likelihood of their occurrence and potential significance. This list is not necessarily exhaustive.

Using sitagliptin and simvastatin alongside any of these drugs listed below would not be recommended. Your prescribing doctor might choose not to give you sitagliptin and simvastatin for this particular course of treatment, or might choose instead to alter the other drugs that you take.

  • Voriconazole
  • Tipranavir
  • Telithromycin
  • Telaprevir
  • Saquinavir
  • Ritonavir
  • Posaconazole
  • Paritaprevir
  • Nelfinavir
  • Nefazodone
  • Mifepristone
  • Mibefradil
  • Lopinavir
  • Ketoconazole
  • Itraconazole
  • Indinavir
  • Idelalisib
  • Gemfibrozil
  • Fosamprenavir
  • Erythromycin
  • Darunavir
  • Danazol
  • Cyclosporine
  • Cobicistat
  • Clarithromycin
  • Boceprevir
  • Atazanavir
  • Amprenavir

Using Sitagliptin and simvastatin alongside the following drugs is normally not recommended. However, it might be necessary in some circumstances. Should both medications be prescribed at the same time, your prescribing doctor might amend the dosage of Sitagliptin and simvastatin or the other drug, or they might choose to amend how often a dosage should be taken.

  • Warfarin
  • Verapamil
  • Tosufloxacin
  • Thioctic Acid
  • Tadalafil
  • Sparfloxacin
  • Simeprevir
  • Rufloxacin
  • Risperidone
  • Ranolazine
  • Quinupristin
  • Prulifloxacin
  • Pefloxacin
  • Pazufloxacin
  • Pazopanib
  • Pasireotide
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Niacin
  • Nadifloxacin
  • Moxifloxacin
  • Lumacaftor
  • Lomitapide
  • Lomefloxacin
  • Levofloxacin
  • Lanreotide
  • Gemifloxacin
  • Gatifloxacin
  • Fusidic Acid
  • Flumequine
  • Fluconazole
  • Fleroxacin
  • Fenofibric Acid
  • Fenofibrate
  • Eslicarbazepine Acetate
  • Enoxacin
  • Eltrombopag
  • Eliglustat
  • Diltiazem
  • Delavirdine
  • Daptomycin
  • Dalfopristin
  • Conivaptan
  • Colchicine
  • Clofibrate
  • Ciprofloxacin
  • Ciprofibrate
  • Ceritinib
  • Carbamazepine
  • Bezafibrate
  • Besifloxacin
  • Balofloxacin
  • Azithromycin
  • Amlodipine
  • Amiodarone
  • Acenocoumarol

Using Sitagliptin and simvastatin alongside the medications listed below might result in an increased possibility of exhibiting certain negative effects, but the use of both drugs together might be the most appropriate course of treatment for your condition. Should both drugs be prescribed concurrently, your prescribing doctor might choose to amend your dosage, or the frequency of your dosage of one of the drugs, or perhaps both.

  • Timolol
  • Ticagrelor
  • St. John's Wort
  • Sotalol
  • Rifampin
  • Propranolol
  • Practolol
  • Pindolol
  • Phenytoin
  • Penbutolol
  • Pectin
  • Oxprenolol
  • Oxcarbazepine
  • Oat Bran
  • Nebivolol
  • Nadolol
  • Metoprolol
  • Metipranolol
  • Levothyroxine
  • Levobunolol
  • Labetalol
  • Interferon Beta
  • Fosphenytoin
  • Esmolol
  • Efavirenz
  • Dronedarone
  • Digoxin
  • Dasatinib
  • Clopidogrel
  • Celiprolol
  • Carvedilol
  • Carteolol
  • Bosentan
  • Bisoprolol
  • Betaxolol
  • Atenolol
  • Alitretinoin
  • Albiglutide
  • Acebutolol

Some drugs ought not be used at the time of eating, or around that time, or ought not be used whilst eating specific foodstuffs, owing to the risk of certain known interactions. Using tobacco or alcohol alongside certain drugs can also result in certain interactions occurring. The interactions listed below were chosen for the likelihood and severity of their impact. The list is not necessarily exhaustive.

Using sitagliptin and simvastatin at the same time as the following items, would normally not be recommended, but it could be unavoidable under certain circumstances. Should the two be used together, your prescribing doctor might choose to amend your dosage, might alter the frequency of your treatment, or might offer specialized instructions regarding your use of tobacco, alcohol, or food.

  • Grapefruit juice
  • Cranberry juice

Warnings

Whenever you decide to take a drug, the risk of taking it ought to be weighed up alongside what good it can do for your condition. This decision should be reached following consultation between you and your prescribing doctor. When prescribed sitagliptin and simvastatin you ought to consider the following:

Inform your prescribing doctor, should you have suffered an allergic, or any other kind of unusual reaction to Sitagliptin and simvastatin, or indeed to any other medication. You should also inform your prescribing doctor should you suffer from any other allergic or negative reactions to others things, including animals, preservatives, dyes, or foods.

There have been no appropriate studies conducted to determine the relationship between age and the impact of Sitagliptin and simvastatin among the pediatric population. Your prescribing doctor will decide if Sitagliptin and simvastatin is an appropriate medication for a younger patient.

Whilst studies have not shown any problems specific to the geriatric population that would preclude or limit the use of Sitagliptin and simvastatin amongst elderly patients, it has been shown that geriatric patients are more prone to kidney problems that come about as a result of age. This could necessitate extra caution, or might require the prescribing doctor to adjust the dosage of Sitagliptin and simvastatin for elderly patients.

Studies in either pregnant women or animals have shown clear evidence of abnormalities presenting in the unborn fetus. Sitagliptin and simvastatin ought not to be used by patients who are currently, or intending to become, pregnant since the inherent risk far outweighs the potential benefits of the treatment.

Appropriate studies conducted amongst women who are breastfeeding have shown that sitagliptin and simvastatin can have harmful effects upon a nursing infant. Patients who are currently breastfeeding should either cease doing so for the duration of their course of treatment with sitagliptin and simvastatin, or an alternative form of medicine should be sought.

You should take sitagliptin and simvastatin precisely as your prescribing doctor recommends. You must not take a larger dosage, nor should you take your medication more regularly, nor should you extend your course of treatment with the drug.

Sitagliptin and simvastatin ought to come with a leaflet providing patient information. Be sure that you read these instructions and that you follow them carefully. Should you have any concerns or questions, be sure to consult your doctor.

Your prescribing doctor will instruct you regarding your diet, testing the levels of sugar in your blood, exercise, and how to adjust your dosage if you are sick. You must always follow the instructions provided by your doctor exactly as provided.

Swallow the sitagliptin and simvastatin tablet whole. Be sure you do not chew, break, or crush it.

If you currently take diltiazem, dronedarone, or verapamil alongside sitagliptin and simvastatin, your dosage of this medication ought not to be above 10 milligrams (mg) or simvastatin and 100 mg of sitagliptin per day, except where your prescribing doctor has directed otherwise. If you currently take amiodarone, amlodipine, lomitapide, or ranolazine, your dosage of this medication ought not to be above 20 milligrams (mg) or simvastatin and 100 mg of sitagliptin per day, as a higher dosage could increase the chance of a muscle injury, and end up resulting in problems with your kidneys.

You should avoid grapefruit juice when on a course of sitagliptin and simvastatin, as grapefruit juice could increase the chance of a muscle injury, and end up resulting in problems with your kidneys.

High levels of alcohol should not be consumed with sitagliptin and simvastatin, as it can result in unwanted effects to the liver.

Chinese patients that take a large amount of niacin (any amount equal to or larger than 1 gram (g) or 1000 milligrams (mg) each day) alongside sitagliptin and simvastatin might increase their risk of suffering a muscle injury. You should consult your doctor should you be Chinese, or come from Chinese ancestry, and also partake of a large amount of niacin. Your prescribing doctor might need to amend your dosage of this medication.

Call your prescribing doctor immediately should your exhibit unexplained muscle weakness, tenderness, or pain, particularly if it is accompanied by a fever or unusual tiredness, as this could be the symptoms of one of a number of serious muscle conditions, including immune-mediated necrotizing myopathy (IMNM), or myopathy.

Call your prescribing doctor immediately should you present with unusual weakness or tiredness, muscles stiffness or pain, muscles spasms or cramps, a fever, diarrhea, or dark-colored urine. These might be the symptoms of a severe muscle condition known as rhabdomyolysis, which has been linked to kidney problems.

You must ensure that any dentist or doctor currently treating you is aware that you are currently on a course of sitagliptin and simvastatin. It may be necessary for you to cease your treatment with this medication should you need to undergo major surgery, suffer a major injury, or should you develop some other kind of serious health complaint.

You should not take any other kind of medication unless it has been discussed with and approved by your prescribing doctor.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Sitagliptin and simvastatin can cause a serious allergic reaction such as angioedema, anaphylaxis, or specific skin conditions, including Stevens-Johnson syndrome. Such reactions have been known to be life-threatening in some cases, and medical attention should be sought immediately. Consult your doctor as soon as possible, should you develop any of these symptoms during your course of treatment with Sitagliptin and simvastatin: swelling of throat, mouth, face, or hands; difficulty with swallowing or breathing; chills or fever; loose, peeling, blistering, itching, or rashes on the skin.

Using Sitagliptin and simvastatin might result in hypoglycemia (that is, low levels of sugar in the blood). This can occur as well should you miss or delay your meals, indulge in more exercise than normal, consume alcohol, take particular medications, or use Sitagliptin and simvastatin alongside other kinds of diabetes medication.

If you exhibit the symptoms of low levels of blood sugar, it is vital that you treat them before they result in your losing consciousness. As different patients exhibit different reactions and symptoms to hypoglycemia, it is essential that you learn the symptoms that you present, in order to treat the onset quickly.

If you do exhibit the symptoms of hypoglycemia, you must check the level of your blood sugar. Should the levels of sugar in your blood prove to be low, you ought to drink a sugar water solution, non-diet soda, or fruit juice; or you ought to eat sugar cubes, honey, corn syrup, or glucose gel or tablets. A glucagon kit is recommended should you suffer from extreme symptoms (including convulsions (seizures) or loss of consciousness. Glucagon is used for emergency situations and is administered via a needle and syringe. Be sure that a family member is aware of how to use the glucagon kit correctly, in case such symptoms should present themselves.

Certain medical conditions can have an impact on the efficacy of Sitagliptin and simvastatin. Be sure that your prescribing doctor is aware of any medical conditions you have, but particularly any of those listed here.

Sitagliptin and simvastatin must be used with caution in any patient suffering from the following conditions, as it can result in side effects becoming worse:

  • Excessive use of alcohol, or a history of same
  • Chinese ancestry
  • Gallbladder stones
  • Uncontrolled hypothyroidism (that is, a thyroid that is underactive)
  • Kidney disease
  • History of liver disease
  • History of pancreas problems

Sitagliptin and simvastatin must be used with caution in any patient suffering from the following conditions, as it can result in an increased risk of the condition presenting itself again:

  • History of angioedema (a swelling of the legs, arms, throat, tongue, lips, or face) whilst taking sitagliptin, or any other type of DPP-4 inhibitor

Sitagliptin and simvastatin should not be used in any patient suffering from the following conditions:

  • Diabetic ketoacidosis (that is, presence of high acid and ketones in the patient’s blood)
  • Severe kidney disease
  • Active liver disease
  • Type 1 diabetes

Sitagliptin and simvastatin must be used with caution in any patient suffering from the following conditions, as the patient might be an at-risk category for suffering kidney or muscle problems:

  • Severe electrolyte disorders
  • Severe endocrine disorders
  • Not well-controlled epilepsy
  • Hypotension (low levels of blood pressure)
  • Recent trauma or major surgery
  • Severe metabolic disorders
  • Sepsis (a severe infection of the patient’s blood)

Sitagliptin and simvastatin must be used with caution in any patient suffering from the following conditions, as it may worsen the impact of the condition:

  • History of muscle weakness, tenderness, or pain

Storage

Sitagliptin and simvastatin should also be stored in a secure container. It should be kept from freezing at all times and stored at room temperature. Ensure that you keep your supply of Sitagliptin and simvastatin away from direct light, moisture, and heat.

Sitagliptin and simvastatin should always be kept beyond the reach of children.

If you no longer require your Sitagliptin and simvastatin solution, or if it should become outdated, you should not keep it.

Be sure to consult your medical professional before disposing of any unwanted or outdated Sitagliptin and simvastatin.

Summary

Simvastatin and sitagliptin is a combination drug used in the treatment of Type 2 diabetes and hypercholesterolemia in patients where they occur concurrently.

Sitagliptin works by promoting increased levels of insulin production in the pancreas, whilst simultaneously sending a signal to the patient’s liver to inhibit the production of glucose in the blood.

Simvastatin works by inhibiting the production of cholesterol in the body, thus reducing the presence of cholesterol in a patient’s blood.

 

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Last Reviewed:
February 01, 2018
Last Updated:
January 27, 2018