[NP-Clinical] Januvia

[Amy Kinzie ANP]

Hi

we are an endocrine practice, and have been starting to use this. so far there are no particular side effects and it is well tolerated. I agree with you that this is a suboptimal dose, and certianly inadequate for a patient with an A!C of 10.5!  He needed a minimum of Amaryl 4 mg bid, if not i(preferably) insulin until his bgs come under control.

You are correct in your assessment, and in your attempt to intercede for the patient. one can only hope this patient will be seen soon by someone who will intervene with appropriate therapy.

Amy Kinzie, ANP
Endocrinology, Diabetes and Thyroid
  ----- Original Message ----- 
  From: AnnMarie Roetzer 
  To: NP Clinical 
  Sent: Monday, January 08, 2007 10:31 AM
  Subject: [NP-Clinical] Januvia


  Hello group - 

  Just wondering how many people have been using this medication with success.  I had been using it during my last clinical rotation and had seen success with it, but I have rarely seen in used by the PCPs in the area.

  Last week I was working as a nurse at the hospital and one of the cardiologist decided to prescribe this for a patient.  He was 44 y/o A1C of 10.6 and had just had an MI.  However even though the recommended dose is 100mg daily (which is adjusted for renal failure, which the patient had none) he sent the patient home on 25mg daily.  

  I questioned it and he said that is the most appropriate dose.  Is he wrong, just hesistant to use the medication or am I just confused?  Seems to me that without contraindications the drug should be prescribed at the recommended dose.  Anyone who can help out with this would be appreciated.  I felt uncomfortable sending the pateint home with a sub-optimal dose, but couldn't really do much about it.  Even the pharmacist at the hospital didnt know anything about the drug since it is currently not carried by the hospital.

  Thanks,
  AnnMarie

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