Alogliptin

How it works

It inhibits DPP-4, prolonging the action of incretin hormones such as GLP-1 and GIP, which enhances glucose-dependent insulin secretion and suppresses glucagon release.

Prescribing in practice

• Acute pancreatitis has been reported with DPP-4 inhibitors, so it should be stopped if pancreatitis is suspected and avoided in those with a history of it.
• The dose should be reduced in renal impairment, requiring assessment of renal function before and during treatment.
• It is weight-neutral and carries a low risk of hypoglycaemia alone, but this risk rises when combined with a sulfonylurea or insulin.

Monitoring

Monitor glycaemic control (including HbA1c) and renal function, and remain alert for symptoms of pancreatitis or hypersensitivity reactions.

Counselling the patient

• A daily tablet that lowers blood sugar in type 2 diabetes.
• Seek urgent advice for severe, persistent abdominal pain, which could indicate pancreatitis.
• Continue diet, exercise and blood glucose monitoring as advised.

Evidence & guidelines

Alogliptin is an established DPP-4 inhibitor for type 2 diabetes, with its pancreatitis and renal precautions reflected in NICE guidance and the SPC.