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Home Formulary 6.0 Endocrine 6.1 Diabetes 6.1.2 Antidiabetic drugs 6.1.2.3 Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)

6.1.2.3 Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)

ChoiceDrug
1st choiceSitagliptin tablets 25mg, 50mg, 100mg
2nd choiceLinagliptin tablets 5mg

Prescribing Notes

  • Prescribe as per NICE NG28 See also NICE visual summary for blood glucose lowering therapy in adults with type 2 diabetes.
  • DPP-4 inhibitors have been shown to have a modest impact on HbA1c with mean reduction of 0.6-0.8%, but there is no data on morbidity, mortality or long-term adverse effects. Review after 6 months to assess benefit.
  • The DPP-4 inhibitors differ in terms of their licensed indications / combinations.
  • Sitagliptin has the greatest clinical experience and widest range of licensed indications and has demonstrated cardiovascular safety in outcome trials.
  • A small increased risk of acute pancreatitis has been identified for all licensed DPP-4 inhibitors. Patients should be informed of the characteristic symptoms of acute pancreatitis – persistent, severe abdominal pain (sometimes radiating to the back) – and encouraged to tell their healthcare provider if they have such symptoms. Refer to MHRA for full details.

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