Suicide attempt by an overdose of sitagliptin, an oral hypoglycemic agent: A case report and a review of the literature

Abstract

DipeptiDyl peptiDase-4 (Dpp-4) inhibitors have recently been approved worldwide for the management of diabetes. Although insulin is a wellknown anti-diabetic agent that is occasionally used for attempting suicide, the effect of an oral overdose of anti-diabetic agents, such as sitagliptin, a DPP-4 inhibitor, remains unclear. The incidence of hypoglycemia across a range of sitagliptin doses (50, 100, and 200 mg) in a 12-week double-blind randomized controlled study in Japanese patients with type 2 diabetes mellitus was as low as 1.3-4.4% [1]. We present a case report of sitagliptin overdose in a suicide attempt. We also review the literature on overdose with oral antidiabetic agents, and highlight the best use of oral anti- abstract. Dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral hypoglycemic agents for the management of diabetes that elevate the plasma concentration of active glucagon-like peptide-1 via inhibition of DPP-4. They effectively lower not only glycosylated hemoglobin levels, but also fasting and postprandial plasma glucose levels. Patients with diabetes occasionally consume an overdose of oral hypoglycemic agents in suicide attempts: the prevalence of depression is high in patients with diabetes, and depression is a strong risk factor for suicide. We encountered an 86-year-old woman with type 2 diabetes and depression, who was transferred to the emergency room 4h after ingestion of 1,700 mg of the DPP-4 inhibitor sitagliptin (1,700 mg is 17 times greater than the approved maximum dose). Upon arrival, she was fully conscious, plasma glucose was 124 mg/dL, and serum immunoreactive insulin level was 5.81 μU/mL. Thereafter, the plasma concentration of sitagliptin rose to 3,793 nM, which is 4.5 times higher than the value found under regular treatment with the maximum dose. The patient did not suffer from hypoglycemia, suggesting that a single oral overdose of sitagliptin is unlikely to cause hypoglycemia. A literature review of oral anti-diabetic agents revealed that overdose of biguanides is occasionally fatal when immediate intensive care is not provided. In summary, sitagliptin is a good treatment option for diabetic elderly patients or patients with psychiatric disorders who are suicidal and do not require insulin.Key words: Dipeptidyl peptidase-4 inhibitors, Hypoglycemia, Overdose, Sitagliptin diabetic agents in elderly people and in patients with psychiatric disorders. Case ReportAn 86-year-old woman with a 10-year history of type 2 diabetes mellitus was admitted to our hospital after sitagliptin overdose (1,700 mg: 34 tablets, 50 mg each) in a suicide attempt. She had been suffering from depression, and was prescribed sitagliptin 50 mg/day for 10 months; her HbA1c levels were stable at about 7.9% (National Glycohemoglobin Standardization Program). On admission, she was conscious and alert. Her blood pressure was 124/80 mm Hg and body temperature was 36.5°C. Blood glucose and immunoreactive insulin levels were 124 mg/dL and 5.81 μU/mL, respectively. Other laboratory data were a...

Diabetes mellitus and suicide

“…Other medications that have been used in excess quantities with suicidal intent include liraglutide, phenformin, and sitagliptin. [455152]…”

Sitagliptin induced splenic infarcts

“…The adverse effect profile DPP-4 inhibitors is similar to that of placebo and no adverse effects have been reported even with overdose of DPP-4 inhibitors [3,4]. Furukawa et al, reported no adverse effects in a 86-year-old woman with type 2 diabetes and depression, after ingestion of 1,700 mg of sitagliptin (17 times greater than the approved maximum daily dose) with suicidal intent [3].…”

“…Furukawa et al, reported no adverse effects in a 86-year-old woman with type 2 diabetes and depression, after ingestion of 1,700 mg of sitagliptin (17 times greater than the approved maximum daily dose) with suicidal intent [3]. In another reported case, an overdose of sitagliptin 3500 mg (35 times greater than the approved maximum daily dose) did not lead to any adverse events [4].…”

Dipeptidyl peptidase-4 inhibitors

“…Along similar lines, the overall good safety profile of the DPP-4 inhibitors makes them a good option for treatment of individuals with psychiatric disorders where a risk of overdose may exist [20].…”