Dipeptidylpeptidase-4 inhibitors

Question 1

What are they indicated for?

Answer 1

In type 2 diabetes either as a combination therapy with metformin (or other diabetes drugs) or monotherapy if metformin is contraindicated or not tolerated

Question 2

How do they work?

Answer 2

They inhibit DPP-4 thereby lowering blood glucose by preventing incretin degradation

Question 3

Are they more or less likely to cause hypoglycaemia than sulphonylureas?

Answer 3

Less as incretin is glucose dependent so only occurs when blood glucose is elevated

Question 4

What are there side effects?

Answer 4

GI upset
Headache
Nasopharyngitis
Peripheral oedema
Hypoglycaemia can occur especially when used in combination

Question 5

What do all DPP-4 inhibitors carry the risk of causing?

Answer 5

Acute pancreatitis suspect if patient complains of abdominal pain

Stop med and it usually resolves after that

Question 6

What are the warnings for this drug class?

Answer 6

Contraindicated in people with history of hypersensitivity to the drug class

should not be used in the treatment type 1 diabetes or ketoacidosis

Caution in older people >80 years and those with history of pancreatitis

Question 7

Can they be used in pregnancy and breastfeeding?

Answer 7

They should be avoided lack of evidence in use for humans.

Question 8

What are the potential interactions for this drug class?

Answer 8

Antihyperglycaemic drugs sulphonylureas and insulin, and by alcohol
Beta-blockers may mask symptoms of hypoglycaemia

Reduced efficacy of DPP-4 inhibitors with drugs that elevate blood glucose e.g. prednisolone, thiazide and loop diuretics

Question 9

What are the names of drugs in this class?

Answer 9

sitagliptin, linagliptin, alogliptin