title: 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 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.
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan. shinya.furukawa@gmail.com
authors.forename: Shinya
authors.initials: S
authors.lastname: Furukawa
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Teruki
authors.initials: T
authors.lastname: Miyake
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Ueda
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Niiya
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Nishino
authors.forename: Shigeto
authors.initials: S
authors.lastname: Murakami
authors.forename: Masato
authors.initials: M
authors.lastname: Murakami
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
mesh_terms: D000369:Aged, 80 and over; D001645:Biguanides / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects; D003866:Depressive Disorder; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D062787:Drug Overdose / Q000188:drug therapy; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D011719:Pyrazines / Q000009:adverse effects*; D000068900:Sitagliptin Phosphate; D013406:Suicide, Attempted / Q000523:psychology*; D013453:Sulfonylurea Compounds / Q000009:adverse effects; D014230:Triazoles / Q000009:adverse effects*
chemical_list: D001645:Biguanides; D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D011719:Pyrazines; D013453:Sulfonylurea Compounds; D014230:Triazoles; D005947:Glucose; D000068900:Sitagliptin Phosphate