Cough did not recur, but she stopped the sitagliptin because of dyspnea. Dyspnea resolved within one day, and rhinorrhea in 2 days. selleck catalog Two weeks later, her FEV1FVC had increased to 79. 1%, FEF25% 75% to 69% of predicted, and PEFR to 320 Lmin. The next year while off sitagliptin, her maximum rhinorrhea score during the tree pollen season was 510. Fatigue at the end of her first sitagliptin treatment period was 710. This dropped to 410 after stopping the drug. During the challenge period, her fatigue again reached 710. Fatigue decreased to 310 within 3 days of stopping the sitagliptin challenge, and remained low throughout her tree pollen rhinitis season. Case 3 A morbidly obese 55 yr old African American woman had metabolic syndrome, atopic and aspirin induced asthma and rhinitis, and history of ACEI cough.

Atopy and asthma were controlled by inhaling one puff of 500 ug fluticasone propionate50 ug salmeterol twice per day, fexofenadine, nasal mometasone, occassional nebulized budesonide plus levalbuterol treat ments, and omalizumab. Sita gliptin was added to metformin and glucophage. She noted progressive fatigue and loss of energy, Inhibitors,Modulators,Libraries but no cough or alteration Inhibitors,Modulators,Libraries in her intermittent pat tern of wheezing. Although she lost 20 kg, sitagliptin did not improve glucose control, and so it was discontinued. Several months later the drug was restarted to maintain the weight reduction. Eight weeks later she reported increased fatigue, cough, and dyspnea. PEFR was persistently low at 250 Lmin.

She promptly developed a parainfluenza infection complicated by acute rhinosinus itis that required azithromycin, and a prolonged asthma exacerbation that required 6 weeks of prednisone and nebulized budesonide and levalbuterol. This was her worst exacerbation in over three years, and Inhibitors,Modulators,Libraries was temporally related to restarting the sitagliptin. Case 4 This 66 yr old male developed fatigue, rhinorrhea, cough and sensation of wheezing after 8 weeks of sitagliptin. These symptoms cleared after discontinuing the drug. Sitagliptin was Inhibitors,Modulators,Libraries restarted to determine the relationship to his symptoms. Symptom scores increased to 310, but PEFR was not recorded. Again the sitagliptin was stopped. Symptom scores dropped to 110 and PEFR improved by 11% after 1 week off sitagliptin. His chal lenge was for proof of principle and sitagliptin was dis continued before severe symptoms developed.

Case 5 Sitagliptin caused rhinorrhea, cough, dyspnea and fatigue in this 71 yr old female. Symptoms cleared Inhibitors,Modulators,Libraries after stopping the drug. She had moderately severe allergic rhinitis with intermittent asthma, selleck chem Gefitinib but used nasal fluticasone propi onate occasionally for relief of the most severe symptoms. However, during sitagliptin challenge, she adhered strictly to daily inhaled and intranasal mometasone furoate. Her symptoms did not recur despite entering her generally severe fall ragweed season.