Drug-Induced Itching in Diabetes Management

Mechanism and Presentation

The mechanisms of drug-induced itching include direct drug or metabolite deposition in the skin and alteration of neural signaling pathways, according to the American College of Physicians 1
DPP-4 inhibitors like sitagliptin have been noted to cause urticaria and bullous pemphigoid that may present with itching, as reported by the American Diabetes Association 2

The initial assessment of itching should determine if it is associated with visible skin changes or occurs without rash, as recommended by the European Society for Medical Oncology 3
For mild itching, treatment options include topical moderate-potency corticosteroids, non-sedating antihistamines, and sedating antihistamines, according to the European Society for Medical Oncology 4
For moderate to severe itching, consideration of temporary interruption of the medication, oral antihistamines, and application of emollients may be necessary, as suggested by the European Society for Medical Oncology 4

Patients with a history of urticaria or other allergic skin conditions may be at higher risk for developing drug-induced itching, and should be monitored closely, as noted by the American Diabetes Association 2
Documentation of the reaction in the patient's medical record is crucial to inform future prescribing decisions, according to the American College of Physicians 1

If itching occurs with glipizide, switching to another class of antidiabetic medication rather than another sulfonylurea may be considered, due to potential cross-reactivity, as recommended by the American Diabetes Association 2
If itching occurs with sitagliptin, alternative classes of diabetes medications such as metformin, GLP-1 receptor agonists, or SGLT2 inhibitors may be considered, according to the American Diabetes Association 2