Alogliptin (Vipidia) 💊
Key point: DPP-4 inhibitors (e.g., alogliptin) usually do not cause hypoglycaemia on their own. 🚫🍬
There is, however, an important safety concern: gliptins may rarely trigger acute pancreatitis. 🩺🔥
📘 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.
⚙️ Mode of Action
- Inhibits dipeptidyl peptidase-4 (DPP-4), an enzyme that breaks down incretin hormones.
- Prolonged incretin action → ⬆️ insulin secretion (glucose-dependent) and ⬇️ glucagon secretion → lower blood glucose.
- No direct effect on gastric emptying or satiety (unlike GLP-1 analogues).
💊 Indication & Dose
- Type 2 Diabetes Mellitus (usually in combination with other agents):
Alogliptin 25 mg OD PO.
🔄 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).
⚠️ Cautions
- Renal impairment:
- eGFR 30–50 → reduce to 12.5 mg OD.
- eGFR <30 → reduce to 6.25 mg OD.
- Monitor for symptoms of pancreatitis (persistent severe abdominal pain, often radiating to the back).
📝 Prescribing Advice
- DPP-4 inhibitors are weight neutral ⚖️ and generally safe in older adults.
- They do not cause hypoglycaemia unless used with sulfonylureas or insulin → 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.
📊 Dose Range (Always check BNF)
| Name | Starting Dose | Frequency | Route |
| Alogliptin | 25 mg | OD | PO |
🚫 Contraindications
- History of pancreatitis.
- Severe heart failure (NYHA class III–IV).
💥 Side Effects
- GI: Abdominal pain, dyspepsia, reflux.
- Neuro: Headache, dizziness.
- Dermatological: Rash, pruritus.
- Rare but important: Acute pancreatitis.
