Key point: DPP-4 inhibitors (e.g., alogliptin) usually do not cause hypoglycaemia on their own. π«π¬
There is, however, an important safety concern: gliptins may rarely trigger acute pancreatitis. π©Ίπ₯
π About
- Always check the BNF for latest prescribing guidance.
- Useful in patients where hypoglycaemia or weight gain from sulfonylureas/insulin is problematic.
- Can be combined with metformin, sulfonylureas, pioglitazone, SGLT2 inhibitors, or insulin.
βοΈ Mode of Action
- Inhibits dipeptidyl peptidase-4 (DPP-4), an enzyme that breaks down incretin hormones.
- Prolonged incretin action β β¬οΈ insulin secretion (glucose-dependent) and β¬οΈ glucagon secretion β lower blood glucose.
- No direct effect on gastric emptying or satiety (unlike GLP-1 analogues).
π Indication & Dose
- Type 2 Diabetes Mellitus (usually in combination with other agents):
Alogliptin 25 mg OD PO.
π Interactions
- Always cross-check in the BNF for enzyme-mediated drug interactions.
- Particular caution with sulfonylureas or insulin (risk of hypoglycaemia if doses are not adjusted).
β οΈ Cautions
- Renal impairment:
- eGFR 30β50 β reduce to 12.5 mg OD.
- eGFR <30 β reduce to 6.25 mg OD.
- Monitor for symptoms of pancreatitis (persistent severe abdominal pain, often radiating to the back).
π Prescribing Advice
- DPP-4 inhibitors are weight neutral βοΈ and generally safe in older adults.
- They do not cause hypoglycaemia unless used with sulfonylureas or insulin β consider dose reduction of the latter.
- Alogliptin is commonly used first line within this class, except in significant renal impairment where linagliptin (not renally cleared) is preferred.
π Dose Range (Always check BNF)
Name | Starting Dose | Frequency | Route |
Alogliptin | 25 mg | OD | PO |
π« Contraindications
- History of pancreatitis.
- Severe heart failure (NYHA class IIIβIV).
π₯ Side Effects
- GI: Abdominal pain, dyspepsia, reflux.
- Neuro: Headache, dizziness.
- Dermatological: Rash, pruritus.
- Rare but important: Acute pancreatitis.