| Choice | Drug | Dosage |
|---|---|---|
| First choices | Alogliptin tablets 6.25mg, 12.5mg,25mg | Dose: 25mg once daily Reduce dose to: 12.5mg once daily if eGFR 30-50mL/ min 6.25mg once daily if eGFR <30mL/min |
| Or | ||
| Sitagliptin tablets 25mg, 50mg, 100mg | Dose: 100mg once daily Reduce dose to: 50mg once daily if eGFR 30-50mL/min 25mg once daily if eGFR <30mL/min or End Stage Renal Disease | |
| 2nd choice | Linagliptin tablets 5mg | Dose: 5mg once daily (no dose reduction needed in renal impairment) |
Prescribing Notes
- Prescribe as per NICE Guideline NG28 recommendations. 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.
- Some factors to consider when choosing between DPP-4 inhibitors:
- alogliptin is the most cost-effective option. Regarding cardiovascular safety, it has published outcome data demonstrating non-inferiority to placebo in patients with acute coronary syndrome
- sitagliptin has the greatest clinical experience and widest range of licensed indications and has demonstrated cardiovascular safety in outcome trials
- linagliptin does not require dose reduction in renal impairment 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 advice for full details.