Increased concentrations of the incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are released into the bloodstream from the small intestine in response to meals. These hormones cause insulin release from the pancreatic beta cells in a glucose-dependent manner but are inactivated by the DPP-4 enzyme within minutes. GLP-1 also lowers glucagon secretion from pancreatic alpha cells, reducing hepatic glucose production. In patients with type 2 diabetes mellitus, concentrations of GLP-1 are reduced but the insulin response to GLP-1 is preserved. Alogliptin is a DPP-4 inhibitor that slows the inactivation of the incretin hormones, thereby increasing their bloodstream concentrations and reducing fasting and postprandial glucose concentrations in a glucose-dependent manner in patients with type 2 diabetes mellitus. Alogliptin selectively binds to and inhibits DPP-4 but not DPP-8 or DPP-9 activity in vitro at concentrations approximating therapeutic exposures.

Indicated for adults with type 2 diabetes mellitus, to improve glycemic control as an adjunct to diet and exercise.

The recommended dosage of alogliptin tablets is 25 mg taken orally once daily. Do not spilt tablet.

Common (>4%): Nasopharyngitis, headache, upper respiratory tract infections.

Serious postmarketing events:

• Hepatic failure
• Rhabdomyolysis
• Bullous pemphigoid
• Acute pancreatitis

Serious hypersensitivity reactions, such as:

• Anaphylaxis

• Angioedema

• Stevens-Johnson Syndrome

• Pancreatitis: Discontinue if suspected.

• Heart failure: Caution in at-risk patients; monitor closely.

• Hypersensitivity reactions: Severe allergic responses may occur.

• Hepatic failure: Some fatal cases reported; monitor liver enzymes.

• Hypoglycemia: When combined with insulin or insulin secretagogues.

• Arthralgia: Severe joint pain reported.

• Bullous pemphigoid: Blistering skin conditions; discontinue if suspected.