DPP-4 inhibitor Pregnancy: No data in pregnant women; as a precautionary measure it is preferable to avoid use during pregnancy. It is unknown whether alogliptin is excreted in human milk (excreted in animal milk) — a risk to the suckling child cannot be excluded.

Alogliptin

Brand names: Vipidia, Nesina

Alogliptin is an oral dipeptidyl peptidase-4 (DPP-4) inhibitor used to improve glycaemic control in adults with type 2 diabetes mellitus.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 25 mg (one tablet)

Route: Oral — with or without food; swallow tablets whole with water

Frequency: Once daily

Adults aged 18 years and over. Used as add-on therapy to metformin, a thiazolidinedione, a sulphonylurea or insulin, or as triple therapy with metformin and a thiazolidinedione or insulin. When used with metformin and/or a thiazolidinedione, maintain the dose of those agents and give alogliptin concomitantly. When used with a sulphonylurea or insulin, a lower dose of the sulphonylurea or insulin may be considered to reduce the risk of hypoglycaemia. Caution with metformin plus a thiazolidinedione (increased hypoglycaemia risk with triple therapy) — consider a lower thiazolidinedione or metformin dose. Available as 25 mg, 12.5 mg and 6.25 mg film-coated tablets. Hepatic impairment: no dose adjustment for mild to moderate (Child-Pugh 5 to 9); not recommended in severe (Child-Pugh above 9). Elderly: no adjustment based on age, but dose conservatively in advanced age due to potential decreased renal function. Paediatric: safety and efficacy in under-18s not established and no posology recommendation can be made; alogliptin should not be used in the paediatric population because of lack of efficacy. Missed dose: take as soon as remembered; do not take a double dose on the same day. Note: SPC section 4.5 (interactions) was not captured in the fetched bundle — clinician to confirm interactions against the full UK SPC.

Dose adjustments

Renal

Mild renal impairment (CrCl above 50 to 80 mL/min or less): no dose adjustment. Moderate (CrCl 30 to 50 mL/min or less): one-half the recommended dose — 12.5 mg once daily. Severe (CrCl below 30 mL/min) or end-stage renal disease requiring dialysis: one-quarter the recommended dose — 6.25 mg once daily; may be given without regard to the timing of dialysis (experience in dialysis patients is limited; not studied in peritoneal dialysis). Assess renal function before initiation and periodically thereafter.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
History of a serious hypersensitivity reaction — including anaphylactic reaction, anaphylactic shock and angioedema — to any dipeptidyl peptidase-4 (DPP-4) inhibitor

Side effects

Headache (most common adverse reaction with 25 mg alogliptin)
Upper respiratory tract infections and nasopharyngitis (common)
Abdominal pain, gastro-oesophageal reflux disease, diarrhoea (common)
Pruritus and rash (common)
Hypoglycaemia (common); acute pancreatitis, hepatic dysfunction including hepatic failure, hypersensitivity/angioedema, Stevens-Johnson syndrome, erythema multiforme and bullous pemphigoid (frequency not known)

Interactions

Sulphonylureas or insulin — increased risk of hypoglycaemia in combination; a lower dose of the sulphonylurea or insulin may be considered (§4.2, §4.4)
Thiazolidinedione plus metformin (triple therapy) — increased risk of hypoglycaemia observed; consider a lower dose of the thiazolidinedione or metformin (§4.2, §4.4)
Not studied in combination with SGLT-2 inhibitors or GLP-1 analogues, nor formally as triple therapy with metformin and a sulphonylurea (§4.4)

Clinical monograph

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.

Reference: SmPC Vipidia; EXAMINE trial NEJM 2013; 369:1327-35; NICE NG28 (T2DM 2022); ADA Standards of Care 2024; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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