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DPP-4 inhibitor Pregnancy: Avoid — switch to insulin pre-conception and during pregnancy. Limited human data.

Alogliptin

Brand names: Vipidia, Nesina

Adult dose

Dose: 25 mg OD
Route: Oral
Frequency: Once daily
Max: 25 mg/day
Can be taken with or without food. Used as monotherapy or in combination (commonly with metformin — Vipdomet combo product).

Dose adjustments

Renal

CrCl 30–59 ml/min: 12.5 mg OD. CrCl <30 ml/min or ESRD: 6.25 mg OD.

Hepatic

Mild–moderate: no adjustment. Severe (Child-Pugh C): not recommended — limited data.

Clinical pearls

  • Weight-neutral and low hypoglycaemia risk — useful in elderly or those at falls risk.
  • Modest HbA1c reduction (~0.5–0.8%) — generally less effective than SGLT2i or GLP-1 RA.
  • EXAMINE trial (NEJM 2013) confirmed cardiovascular safety post-ACS — non-inferior to placebo for MACE.
  • Saxagliptin showed ↑ HF hospitalisation in SAVOR-TIMI; alogliptin signal less clear but caution in HF.
  • Stop and assess for pancreatitis if severe persistent abdominal pain.
  • DPP-4 inhibitors lose preferred place in NICE NG28 (2022 update) — SGLT2i or GLP-1 RA preferred where CV/renal disease present.

Contraindications

  • Type 1 diabetes
  • Diabetic ketoacidosis
  • Severe hepatic impairment
  • Hypersensitivity (severe rash, anaphylaxis, angioedema with previous DPP-4i)
  • Prior pancreatitis (relative — class warning)

Side effects

  • Nasopharyngitis, headache
  • Hypoglycaemia (when combined with sulphonylurea or insulin)
  • Pancreatitis (rare — class effect; counsel about persistent severe abdominal pain)
  • Severe joint pain (FDA warning 2015 — class effect; usually reversible on stopping)
  • Bullous pemphigoid (rare)
  • Rash, urticaria

Interactions

  • Sulphonylureas / insulin: ↑ hypoglycaemia risk — reduce sulphonylurea/insulin dose by 25–50%
  • CYP interactions are minimal

Monitoring

  • HbA1c 3-monthly until target, then 6-monthly
  • Renal function annually (more frequently if CKD)
  • Vigilance for pancreatitis and severe joint pain

Reference: BNF 90; SmPC Vipidia; EXAMINE trial NEJM 2013;369:1327-35; NICE NG28 (T2DM 2022); ADA Standards of Care 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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