DPP-IV Inhibitors

Who?

DPP-IV inhibitors are recommended for patients with type 2 diabetes who have poorly controlled blood glucose and high Hb A1c levels. On average, most patients find that their A1c levels drop by 0.5-1.0% on these medications.

What?

Oral tablets

A few types of DPP-IV inhibitors are available. Some examples are:

Many of the above are also sold in a pill combined with metformin

Where?

These medications prevent the breakdown of a hormone released by the gut called GLP-1, which helps the pancreas release insulin. This hormone is normally broken down by an enzyme called DPP-IV. Because these drugs block the activity of the DPP-IV enzyme, they are called DPP-IV inhibitors. Allowing GLP-1 to stay in the body longer than usual results in the pancreas releasing more insulin, but without the risk of hypoglycemia. This helps prevent high blood glucose levels.

When?

These medications can be taken with or without food. The treatment plan will differ for each patient, but in general:

Sitagliptin is taken once a day; the doctor will prescribe doses of either 50 or 100 mg.
Saxagliptin is taken once a day; the doctor will prescribe doses of either 2.5 or 5 mg.
Linagliptin is taken once a day; the doctor will typically prescribe a dose of 5mg daily.
Alogliptin is taken once a day; the doctor will typically prescribe a dose of 25mg daily

Combination pills with metformin are typically taken twice daily, as metformin is a twice daily medication.

IMPORTANT NOTE: Dose reductions are typically needed for some of these medications in patients with kidney disease. However, it should be noted that the combination pills with metformin may not be safe in those with kidney or liver disease.

Why?

Patients generally don’t gain or lose weight on these medications.
When taken alone, DPP-IV inhibitors do not usually cause low blood glucose.
These medications are usually well tolerated but side effects may include nausea, diarrhea, and abdominal cramps.

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