Dipeptylpeptidase 4 Inhibitors (DPP4i)

Question 1

Give some commonly used DPP4is.

Answer 1

Alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin.

Question 2

What is the mechanism of action of the DPP4is?

Answer 2

Inhibit dipeptylpeptidase-4 (an enzyme which breaks down incretins). Incretins are produced by the gut in response to food and trigger insulin secretion and lower glucagon secretion.

Question 3

Describe the potency of the DPP4is.

Answer 3

Not particularly potent.

Question 4

Do DPP4is come with a risk of hypoglycemia?

Answer 4

Yes. Especially with concomitant use of insulins, sulfonylureas, or metformin.

Question 5

Describe the effect of the DPP4is on weight.

Answer 5

Weight neutral.

Question 6

Sitagliptin use is associated with which specific side effects?

Answer 6

Increased risk of RTIs.

Question 7

Vidagliptin use is associated with which specific side effects?

Answer 7

Headaches.

Question 8

Vidagliptin use is associated with which specific side effects?

Answer 8

GI upset, peripheral oedema, pancreatitis, rare reports of liver impairment.

Question 9

What monitoring is required for patients on vildagliptin?

Answer 9

Monitor liver function before treatment and then every 3 months for the first year, then periodically thereafter.

Question 10

What symptoms of liver dysfunction should patients on vildagliptin look out for?

Answer 10

Nausea, vomiting, abdominal pain, fatigue, dark urine.

Question 11

Patients on DPP4is should stop treatment if symptoms of acute pancreatitis occur. What are these symptoms?

Answer 11

Persistent and severe abdominal pain, nausea, vomiting.