ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
DPP-4 Inhibitor with Biguanide (Fixed-Dose Combination)

Alogliptin with Metformin

Brand names: Vipdomet

Adult dose

Dose: 12.5 mg/850 mg or 12.5 mg/1000 mg twice daily
Route: Oral
Frequency: Twice daily with meals

Clinical pearls

  • Fixed-dose combination improves adherence when both components are required
  • Alogliptin (DPP-4 inhibitor) is weight-neutral and low hypoglycaemia risk when used without sulphonylurea/insulin
  • NICE NG28 (Type 2 diabetes): DPP-4 inhibitors are second-line options
  • Check eGFR before initiating and at least annually — adjust or stop if eGFR falls <45
  • EXAMINE trial: alogliptin showed cardiovascular non-inferiority in high-risk T2DM patients
  • Swallow whole with food to minimise GI side effects

Contraindications

  • eGFR <45 mL/min/1.73 m² (metformin component — risk of lactic acidosis)
  • Acute/chronic metabolic acidosis
  • Hepatic impairment
  • Alcohol misuse
  • Iodinated contrast media — withhold metformin 48 hours before and after if eGFR 30–60
  • Heart failure (acute or decompensated)
  • Conditions predisposing to lactic acidosis

Side effects

  • Gastrointestinal (nausea, diarrhoea, abdominal pain — metformin)
  • Nasopharyngitis, upper respiratory tract infections (DPP-4 class effect)
  • Pancreatitis (rare — DPP-4 class warning)
  • Arthralgia (rare — DPP-4 class)
  • Lactic acidosis (rare but serious — metformin)

Interactions

  • Insulin/sulphonylureas — hypoglycaemia risk if combined; may need dose reduction of those agents
  • Iodinated contrast — withhold metformin component as above
  • Cimetidine — increases metformin levels via renal tubular secretion competition
  • Alcohol — increases lactic acidosis risk with metformin

Monitoring

  • HbA1c (target per NICE NG28: typically 48–53 mmol/mol)
  • eGFR at baseline, 3–6 monthly, and if intercurrent illness
  • LFTs at baseline
  • Lipase if symptoms of pancreatitis develop

Reference: BNF; NICE NG28 (Type 2 diabetes in adults, 2022); EXAMINE trial (NEJM 2013); https://bnf.nice.org.uk/drugs/alogliptin-with-metformin/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways