General

Pronunciation:
al-oh-glip-tin


Trade Name(s)

  • Nesina

Ther. Class.
antidiabetics

Pharm. Class.
dipeptidyl peptidase-4 (DDP-4) inhibitors

Indications

Adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus.

Action

Acts as a competitive inhibitor of dipeptidyl peptidase-4 (DPP-4) which slows the inactivation of incretin hormones, thereby increasing their concentrations and reducing fasting and postprandial glucose concentrations.

Therapeutic Effect(s):

Improved control of blood glucose.

Pharmacokinetics

Absorption: Completely absorbed following oral administration (100%).

Distribution: Well distributed into tissues.

Metabolism and Excretion: Not extensively metabolized, 76% excreted unchanged in urine.

Half-life: 21 hr.

TIME/ACTION PROFILE (inhibition of DPP-4)

ROUTEONSETPEAK†DURATION
POunknown1–2 hr24 hr
†Multiple dosing.

Contraindication/Precautions

Contraindicated in:

  • Type 1 diabetes;
  • Diabetic ketoacidosis;
  • Previous severe hypersensitivity reactions.

Use Cautiously in:

  • Hepatic impairment;
  • Renal impairment (dose ↓ required if CCr <60 mL/min);
  • HF or renal impairment (↑ risk for worsening HF);
  • Geri: May have ↑ sensitivity to effects;
  • Lactation:Use cautiously;
  • OB: Use during pregnancy only if clearly needed;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: headache

CV: HF

Derm: STEVENS-JOHNSON SYNDROME, bullous pemphigoid

GI: HEPATOTOXICITY, PANCREATITIS, ↑ liver enzymes

MS: arthralgia

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS OR ANGIOEDEMA)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

↑ risk of hypoglycemia with sulfonylureas and insulin; dose adjustments may be necessary

Route/Dosage

PO: (Adults) 25 mg once daily.

Renal Impairment
PO: (Adults) CCr 30–59 mL/min– 12.5 mg once daily; CCr 15–29 mL/min– 6.25 mg once daily; CCr <15 mL/min or requiring hemodialysis– 6.25 mg once daily.

Availability

Tablets: 6.25 mg, 12.5 mg, 25 mg

In Combination with:metformin (Kazano), pioglitazone (Oseni).

Assessment

  • Observe for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety).
  • Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back) during therapy. If pancreatitis occurs, discontinue alogliptin and monitor serum and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, and lipase.
  • Assess for signs and symptoms of HF (increasing shortness of breath, rapid increase in weight, swelling of feet) periodically during therapy.
  • Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.

Lab Test Considerations: Monitor hemoglobin A1C prior to and periodically during therapy.

  • Monitor liver function tests prior to starting and periodically during therapy. Interrupt therapy and determine cause if significant ↑ in enzymes or abnormal tests persist or worsen. Do not restart therapy without explanation for abnormalities.
  • Monitor renal function prior to and periodically during therapy.

Potential Diagnoses

Implementation

  • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
  • PO: May be administered without regard to food.

Patient/Family Teaching

  • Instruct patient to take alogliptin as directed. Take missed doses as soon as remembered, unless it is almost time for next dose; do not double doses. Advise patient to read Medication Guide before starting and with each Rx refill in case of changes.
  • Explain to patient that alogliptin helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
  • Instruct patient not to share this medication with others, even if they have the same symptoms; it may harm them.
  • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
  • Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
  • Instruct patient in proper testing of blood glucose and urine ketones. These tests should be monitored closely during periods of stress or illness and health care professional notified if significant changes occur.
  • Advise patient to stop taking alogliptin and notify health care professional promptly if symptoms of hypersensitivity reactions (rash; hives; swelling of face, lips, tongue, and throat; difficulty in breathing or swallowing), liver dysfunction (fatigue, nausea, vomiting, anorexia, right upper abdominal discomfort, dark urine, yellowing of skin or whites of eyes), HF, or pancreatitis occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

Improved hemoglobin A1C, fasting plasma glucose and 2-hr post-prandial glucose levels.

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TY - ELEC T1 - alogliptin ID - 109731 Y1 - 2019 PB - Davis's Drug Guide UR - https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/109731/all/alogliptin ER -