DPP4 Inhibitors - Normal and Renal Dosing



Increase Incretins (GLP-I & GIP) -> Stimulates Insulin, Inhibits Glucagon -> Lowers Blood Sugar (post-prandial) 



Januvia (sitagliptin) 100 mg 

Nesina (alogliptin) 25 mg 

Onglyza (saxagliptin) 5 mg 

Tradjenta (linagliptin) 5 mg



DPP4 inhibitors work by increasing incretins, which will stimulate insulin release in response to food and inhibit glucagon. This mechanism helps lower primarily post-prandial glucose and has very minimal chance of hypoglycemia. One unique thing about this drug class is that you start patients on the highest dose, and only use lower doses if patients have renal insufficiency. This is very different than other medications where you start at the lowest dose and titrate up to effects or target doses. If you see a patient on a lower dose of a DPP4, double check the kidney function to make sure the dose is correct. This drug class has a smaller A1c lowering than others, but is a very tolerable medication with only few side effects.



Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx



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