Alogliptin

1. Introduction

Alogliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used to improve glycaemic control in adults with type 2 diabetes mellitus. It works by increasing incretin hormone levels, which stimulate insulin secretion and reduce glucagon secretion in a glucose-dependent manner.

2. Indications

  • Approved Indications:
    • Adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus.
  • Off-Label Uses:
    • Combination therapy with other antihyperglycaemic agents.

3. Dosage

  • Standard Dose:
    • 25 mg once daily.
  • Dosage Adjustments in Renal Impairment:
    • Moderate renal impairment (eGFR 30–60 mL/min): 12.5 mg once daily.
    • Severe renal impairment or end-stage renal disease (eGFR <30 mL/min): 6.25 mg once daily.

4. Administration

  • Administer orally once daily with or without food.
  • Swallow the tablet whole; do not crush or chew.

5. Forms Available

  • Tablets: 6.25 mg, 12.5 mg, 25 mg.

6. Side Effects

6.1. Common Side Effects

  • Nasopharyngitis.
  • Headache.
  • Upper respiratory tract infections.

6.2. Less Common Side Effects

  • Diarrhoea.
  • Nausea.
  • Weight gain (when combined with other therapies).

6.3. Rare but Serious Side Effects

  • Pancreatitis.
  • Hypersensitivity reactions (e.g., angioedema, Stevens-Johnson syndrome).
  • Hepatic enzyme elevation.

7. Warnings

  • Risk of acute pancreatitis; discontinue if suspected.
  • Monitor for severe joint pain.
  • Avoid use in patients with a history of serious hypersensitivity reactions to DPP-4 inhibitors.

8. Precautions

  • Use with caution in patients with a history of pancreatitis.
  • Monitor liver enzymes periodically.
  • Not recommended for type 1 diabetes or diabetic ketoacidosis.

9. Interactions

  • Drug-Drug Interactions:
    • Enhanced hypoglycaemic risk when combined with sulfonylureas or insulin.
  • Drug-Food Interactions:
    • None significant.

10. Monitoring Parameters

  • Blood glucose (fasting and postprandial).
  • HbA1c (every 3–6 months).
  • Renal function (eGFR) periodically.
  • Signs of pancreatitis or hypersensitivity.

11. Use in Children

  • Safety and efficacy have not been established in paediatric populations.

12. Use in Pregnancy

  • No adequate data in pregnant women.
  • Use only if the potential benefit justifies the risk to the foetus.
  • Animal studies have shown no teratogenic effects.

13. Use in Elderly

  • No dose adjustment needed unless renal impairment is present.
  • Monitor renal function closely due to age-related decline.

14. Use in Kidney Disease

  • Dose adjustments required based on eGFR:
    • Moderate impairment: 12.5 mg once daily.
    • Severe impairment or ESRD: 6.25 mg once daily.

15. Use in Liver Disease

  • Not recommended in severe hepatic impairment due to lack of studies.
  • Use with caution in mild-to-moderate hepatic impairment.

16. Patient Counselling Points

  • Advise on proper dosing and the importance of adherence to diet and exercise.
  • Inform about the signs of pancreatitis (e.g., severe abdominal pain).
  • Report any symptoms of hypersensitivity immediately.
  • Discuss the need for regular blood glucose and HbA1c monitoring.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
NesinaTakeda Pharmaceuticals$200 (30 tablets, 25 mg)
Generic OptionsVarious$50–100 (30 tablets, 25 mg)

18. FAQs (15 Questions)

  1. What is alogliptin used for?
    Alogliptin is used to improve blood sugar control in adults with type 2 diabetes mellitus.
  2. How does alogliptin work?
    It inhibits the DPP-4 enzyme, increasing incretin levels to regulate blood sugar.
  3. Can alogliptin be taken with food?
    Yes, it can be taken with or without food.
  4. What are the common side effects of alogliptin?
    Nasopharyngitis, headache, and upper respiratory infections.
  5. Are there any serious side effects?
    Pancreatitis and severe hypersensitivity reactions are rare but serious.
  6. Can pregnant women use alogliptin?
    It is not recommended unless benefits outweigh risks due to limited data.
  7. Is alogliptin safe for children?
    Safety and efficacy in children have not been established.
  8. How should alogliptin be stored?
    Store at room temperature, away from moisture and heat.
  9. What happens if I miss a dose?
    Take it as soon as you remember, but skip it if it’s near the next dose.
  10. Can I take alogliptin with other diabetes medicines?
    Yes, but monitor for increased risk of hypoglycaemia.
  11. Does alogliptin cause weight gain?
    Not significantly on its own, but may cause weight gain when combined with other agents.
  12. What are the signs of pancreatitis from alogliptin?
    Severe abdominal pain, nausea, and vomiting.
  13. Is alogliptin safe for elderly patients?
    Yes, but monitor renal function regularly.
  14. Does alogliptin affect liver function?
    It can cause liver enzyme elevation; monitoring is advised.
  15. Do I need regular tests while taking alogliptin?
    Yes, blood glucose, HbA1c, and renal function should be monitored regularly.