DPP-4 Inhibitors

Dipeptidyl peptidase-4 (DPP-4 or gliptins) inhibitors are a class of medication to treat Type 2 diabetes. They improve how your body uses insulin, which then lowers your blood sugar (glucose) levels.

How do DPP-4 inhibitors work?

They work by blocking the DPP-4 enzyme. DPP-4 breaks down hormones called incretins (mainly GLP-1 and GIP). These hormones help your pancreas release insulin after you eat. Incretins don’t last long because the DPP-4 enzyme breaks them down quickly. Once DPP-4 is blocked, though, incretins don’t break down as quickly. They remain in your body longer, so you can release insulin when your blood sugar is high. DPP-4 inhibitors suppress glucagon secretion. Glucagon is a hormone that your pancreas produces. It raises blood sugar.

What are examples of DPP-4 inhibitors?

DPP-4 inhibitors have “gliptin” at the end. Examples of FDA-approved medications are:

• Sitagliptin (Januvia®)
• Linagliptin (Tradjenta®)
• Saxagliptin (Onglyza™)
• Alogliptin (Nesina®, Vipidia®)

What dosage strengths do DPP-4 inhibitors come in?

DPP-4 inhibitors are available in different dosage strengths. These medications are typically taken by mouth once per day.

• Sitagliptin comes in 25 milligram (mg), 50 mg and 100 mg tablets.
• Linagliptin comes in just a 5 mg tablet. This is the only dose.
• Saxagliptin comes in 2.5 mg or 5 mg tablets.
• Alogliptin’s standard dose is 25 mg per day, but there are lower dosages available.

Always take DPP-4 inhibitors as prescribed. If you have questions about your dosage or believe it’s not working, contact your healthcare provider. The biggest sign that your medication isn’t working is consistently high blood sugar readings.

What happens if I miss a dose?

You can take your missed dose later in the day if you remember. But if it’s the next day, it’s best to just wait until your next dose. Never take two doses to make up for missing one.

If you miss a dose, your blood sugar readings may be higher that day. But they should stabilize the next day once you take your medication.

What are the benefits of taking DPP-4 inhibitors?

The main benefit is that it can help manage your blood sugar levels if you have Type 2 diabetes.

DPP-4 inhibitors work well with other diabetes medications like metformin, insulin injections and SGLT2 inhibitors. They aren’t usually used with GLP-1 agonists.

What are the risks and side effects of DPP-4 inhibitors?

Some of the most common side effects are:

• Nausea and diarrhea
• Headache
• Stuffy nose and sore throat
• Joint pain

You may be at higher risk for pancreatitis or heart failure (if you have an existing heart condition).

There’s a small risk of extremely low blood sugar. But this typically only happens when you’re taking DPP-4 inhibitors with other diabetes medications.

Who shouldn’t take DPP-4 inhibitors?

This medication isn’t for people with Type 1 diabetes. You may need to avoid or lower your dosage if you have kidney disease or liver disease. If you’re pregnant, breastfeeding or planning to become pregnant, DPP-4 inhibitors may not be for you.

Always share your full medical history with your healthcare provider. This includes all the medications and supplements you take. They can tell you if any of your medications interact with DPP-4 inhibitors.