Diffuse erythematous rash after teneligliptin therapy: A case report.

We report a yet unreported, adverse effect of teneligliptin [Dipeptidyl peptidase IV inhibitor (DPP IV)] presenting as diffuse pruritic erythematous rash, in a patient, 2 days after initiation of the drug. The rash waned off after the discontinuation of the drug without any residual lesion.

Introduction

Relative economic advantage of teneligliptin over other DPP IV inhibitor has propelled its usage in South East Asian countries including India. A generally safe adverse-effect profile has further substantiated its usage. We report appearance of diffuse, pruritic, and erythematous rash after exposure of teneligliptin.

Case

A 49-year-old female with type II diabetes mellitus with poor glycemic control on oral hypoglycemic agents (metformin 1 g with glimepride 2 mg, fixed drug combination in twice daily divided dosage) presented to us. Her BMI was 28.8; she was normotensive with apparently unremarkable systemic examination. Her renal and hepatic function profiles were within clinical limits. Her HBA1C was 8.4 and fasting blood glucose was 150 mg/dl with postprandial blood glucose 212 mg/dl. She was advised teneligliptin 20 mg daily. After exposure of teneligliptin for 2 days, she presented with diffuse erythematous pruritic cutaneous rash. There was no history of fever, lymphadenopathy, and other sign(s) suggestive of infectious etiology. The rash was present all over the limbs and trunk with prominence over the ventral aspect of affected area. Teneligliptin was withdrawn and patient was started on once daily fexofenadine 120 mg and topical emollients. The rash disappeared gradually over next 5–7 days with no residual scarring or hyperpigmentation. Considering it to be not related to exposure of the drug, it was restarted after 15 days which led to the reappearance of rash, subsequently managed as previous exposure. This adverse effect (rash) was scored as per NARANJO scale score of +7.

Discussion

Diabetes mellitus is major public health problem contributing to morbidity and mortality due to its various microvascular and macrovascular complications.[1] DPP IV inhibitors are associated with enhanced beta cell functions, low risk of hypoglycemia, weight gain, and over good tolerability profile.[2] Teneligliptin is a new DPP IV inhibitor which shows a unique chemical structure characterized by five consecutive rings (J shaped), metabolizes through both hepatic and renal routes with no dose adjustment required in patients of hepatic and renal insufficiency. Relatively long half-life (24 h) ensures minimal glycemic fluctuations over the day.[3] Efficacy and safety profile of teneligliptin is similar to other DPP IV inhibitors.[4] This along with economic advantage poised by teneligliptin-based therapies has propelled its usage among both drug naïve as well as co-prescription with other oral hypoglycemic drugs.[5] To the best of authors’ knowledge, there have been reports of cutaneous adverse effects of other DPP IV inhibitors,[6] but similar reports with teneligliptin are unknown. This case report is thus unique in highlighting a yet unreported adverse effect of teneligliptin.

Conclusion

In the present case, the initial generalized skin eruption may have been induced by an allergic reaction to teneligliptin. Close attention should be paid to patients receiving this drug with a history of urticaria and to the development of photosensitivity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.