Incretins: DPP-4 inhibitors marketed in the United States
| Dosing | Sitagliptin (Januvia) | Saxagliptin (Onglyza) | Linagliptin (Tradjenta) | Alogliptin (Nesina) |
|---|---|---|---|---|
| With or without food | 100 mg/day; oral | 2.5–5 mg/day; oral | 5 mg/day; oral | 25 mg/day; oral |
| Renal dose adjustment | Reduce to 50 mg/day if CrCl 30–50 mL/min; reduce to 25 mg/day if < 30 mL/min or ESRD | Reduce to 2.5 mg/day if CrCl < 50 mL/min or ESRD | Fecal elimination route; no renal adjustment needed | Reduce to 12.5 mg/day if CrCl 30–59 mL/min; reduce to 6.25 mg/day if < 30 mL/min or ESRD |
| Hepatic dose adjustment | No clinical experience with severe hepatic insufficiency (Child-Pugh score ≥ 9) | None | None | No clinical trials in severe hepatic insufficiency (Child-Pugh grade C) |
| Elimination half-life | 12.4 hours | 2.5 hours | > 24 hours | 12.5–21.1 hours |
| Comments | Low risk of hypoglycemia | Long half-life; good choice for patients with chronic kidney disease | Long half-life | |
| Similar glycemic efficacy as a class: Agents cause modest improvements in glycated hemoglobin levels Overall, well tolerated; insufficient data regarding association with acute pancreatitis | ||||
CrCl = creatinine clearance; DPP-4 = dipeptidyl peptidase-4; ESRD = end-stage renal disease.
Based on information in Tran L, Zielinski A, Roach AH, et al. Pharmacologic treatment of type 2 diabetes: oral medications. Ann Pharmacother 2015; 49:540–556.