Notes

New Drugs 2013 Part II
..mechanism, drug interaction, side effects, dosing guidelines

Alogliptin Nesima
..mechanism dipeptidyl peptinase-4 DPP-4 inhibitor
..use as adjunct for DM 2 diet and exercise. Not for DM 1
..eating releases glucagon like peptides-1 GLP-1 and
.....glucose dependent insulinotropic polypeptides GIP into blood causing insulin release from pancrease beta cells thus reducing hepatic glucose production but inactivated by DPP -4 enzymes within minutes.
...Alogliptin - DPP-4 inhibitor slows inactivation of in creation hormones thus increase bloodstream glucose concentration and reduces fasting and postprandial glucose concentrations by binding to and inhibitor DPP-4 but not DPP-8,9
....Dose 25 mg QD with/without food normal renal function
....Dose 12.5 mg QD moderate renal function CrCl >30-<60 ml/min
....Dose 6.25 mg QD with severe or dialysis renal function without regard to the timing of dialysis
..Metabolism primarily renally excreted , CYP450 metabolic system negligible thus no DI with CYP system or renally excreted drugs.
..Side Effects >4% nasopharyngitis! headache! Upper Respiratory tract infection.
..serious adverse effects acute pancreatitis thus check pancreas first before starting.
Hypersensitive reaction ie anaphylaxis , angioedema, severe cutaneous ie Stevens-Johnson syndrome DC med if these reactions occur.
..insufficient information re fatal/non fatal hepatic failure. Increase serum alanineaminotransferase >3 times normal observed. Therefore obtain liver panel before starting and ongoing basis to establish probable cause.
..Insulin, insulin secretagogues ie sulfonylureas cause hypoglycemia thus use lower dose Alogliptin
..Pregnancy category B to well controlled studies No problem with animal studies but use only if warranted
..comes 6.25,12.5,25 mgtablets