ANTIDIABETIC DRUGS: DPP-4i

Question 1

MOA

Answer 1

Inhibits dipeptidyl peptidase-4
DPP-4 breaksdown the hormone incretin
Incretin is made by the gut in response to food

Increases insulin secretion
Lowers glucagon secretion

Question 2

Examples

Answer 2

Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin

Question 3

Side effects

Answer 3

Risk of HYPO (esp in combo with insulin or SU or metformin)
Increased risk of upper respiratory tract infection (sitagliptin)
Headache (vidaglitpin)
GI upsets
Peripheral oedema
Pancreatitis
Rare reports of liver impairment (vidagliptin)

Question 4

DPP4i and SU

Answer 4

• both promote insulin release
• less associated with weight gain and hypoglycaemia compared to SU

Question 5

Renal impairment

Answer 5

Dose reduction or caution (linagliptin safe)

Question 6

Hepatic impairment

Answer 6

Dose reduction or caution or AVOID
(not for linagliptin + sitagliptin)

Question 7

Pancreatitis

Answer 7

Counsel patients to report severe, abdominal pain, N+V

Question 8

Vidagliptin monitoring

Answer 8

Monitored for liver function before treatment and every 3 months for the 1st yr and periodically thereafter