Alogliptin

Alogliptin is an oral antidiabetic agent classified as a dipeptidyl peptidase-4 (DPP-4) inhibitor. It is marketed alone as Nesina in the United States and as Galvus in the European Union. The drug works by inhibiting the DPP-4 enzyme, thereby increasing circulating incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). This enhances glucose-dependent insulin secretion and suppresses excessive glucagon release after meals.

Alogliptin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It can be used as monotherapy in patients intolerant to metformin or as add-on therapy with metformin, pioglitazone, or insulin. It is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis.

Pharmacokinetics: Alogliptin is administered orally. It is absorbed with peak plasma concentrations within about one to two hours. The elimination half-life is around 20 hours, supporting once-daily dosing. The drug is predominantly excreted by the kidneys; therefore, dose adjustments are advised in patients with renal impairment.

Safety and adverse effects: Common adverse events include nasopharyngitis, upper respiratory tract infection, and headache. Serious risks include pancreatitis and hypersensitivity reactions such as anaphylaxis or angioedema. Some patients report severe joint pain. As with other DPP-4 inhibitors, alogliptin may have a lower risk of hypoglycemia when used without insulin or secretagogues, but hypoglycemia can occur when combined with insulin or sulfonylureas. Use precaution in patients with a history of pancreatitis or in those at risk for cardiovascular events; consult labeling for updates.

Regulatory status and brand names: In the United States, alogliptin is approved as Nesina; in the European Union it is approved as Galvus. It is also available in combination products such as Galvus Met (with metformin).