Multiple doses of sitagliptin, a selective DPP-4 inhibitor, do not meaningfully alter pharmacokinetics and pharmacodynamics of warfarin

J Clin Pharmacol. 2009 Oct;49(10):1157-67. doi: 10.1177/0091270009341653.

Abstract

Sitagliptin is an orally active, highly selective dipeptidyl peptidase IV (DPP-4) inhibitor for treatment of type 2 diabetes mellitus. This randomized, open-label, 2-part, 2-period crossover study assessed pharmacokinetics/pharmacodynamics of warfarin in the presence/absence of multiple-dose sitagliptin. Twelve participants received treatments A and B separated by >7-day washout: treatment A involved coadministration of sitagliptin 200 mg/d for 11 days (days 1-11) and warfarin 30 mg on day 5, and treatment B involved warfarin 30 mg alone on day 1. R(+) warfarin, S(-) warfarin, and international normalized ratio (INR) were assayed predose and up to 168 hours postdose. The geometric mean ratios (GMRs; warfarin + sitagliptin/warfarin alone) (90% confidence intervals [CIs]) were 0.99 (0.95, 1.03) and 0.95 (0.90, 1.02) for the AUC(0-infinity) of R(+) and S(-) warfarin, respectively. GMRs (warfarin + sitagliptin/warfarin alone) (90% CIs) were 0.89 (0.86, 0.93) and 0.89 (0.86, 0.92) for the C(max) of R(+) and S(-) warfarin, respectively. INR AUC(0-168 h) and INR(max) GMRs were 1.01 (0.96, 1.06) and 1.08 (1.00, 1.17), respectively. Coadministration of sitagliptin and warfarin was generally well tolerated. Pharmacokinetics (AUC for R(+) and S(-) warfarin) and pharmacodynamics (INR of R(+) or S(-) warfarin) were not meaningfully altered following coadministration of multiple-dose sitagliptin and single-dose warfarin, indicating that no dosage adjustment for warfarin is necessary when coadministered with sitagliptin.

Publication types

  • Clinical Trial, Phase I
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anticoagulants / administration & dosage
  • Anticoagulants / pharmacokinetics*
  • Anticoagulants / pharmacology*
  • Cross-Over Studies
  • Dipeptidyl-Peptidase IV Inhibitors / administration & dosage
  • Dipeptidyl-Peptidase IV Inhibitors / adverse effects*
  • Drug Administration Schedule
  • Drug Interactions
  • Female
  • Humans
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Prothrombin Time
  • Pyrazines / administration & dosage
  • Pyrazines / adverse effects*
  • Sitagliptin Phosphate
  • Triazoles / administration & dosage
  • Triazoles / adverse effects*
  • Warfarin / administration & dosage
  • Warfarin / pharmacokinetics*
  • Warfarin / pharmacology*

Substances

  • Anticoagulants
  • Dipeptidyl-Peptidase IV Inhibitors
  • Pyrazines
  • Triazoles
  • Warfarin
  • Sitagliptin Phosphate