Generic Name

Alogliptin and Metformin Hydrochloride

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Classification

FDA Approved Indications

• Management of type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Alogliptin inhibits DPP-4 enzyme, increasing incretin levels which enhance glucose-dependent insulin secretion and decrease glucagon levels. Metformin reduces hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity.

Dosage and Administration

Adult: Since it is a combination, dosage varies; typically, starting doses are based on individual patient needs, often beginning with alogliptin 25 mg once daily and metformin 500 mg once daily, titrated as needed.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; adjust dosing based on renal function and tolerability.

Renal Impairment: Adjust dose or avoid in severe impairment; regular renal function monitoring is necessary.

Hepatic Impairment: Use with caution; not recommended in hepatic disease.

Pharmacokinetics

Absorption: Alogliptin is well absorbed; metformin absorption is variable but generally through the small intestine.

Distribution: Alogliptin has a low volume of distribution; metformin's volume of distribution is approximately 3-5 L/kg.

Metabolism: Alogliptin undergoes minimal metabolism; metformin is excreted unchanged.

Excretion: Primarily via renal excretion—glomerular filtration and renal tubular secretion.

Half Life: Alogliptin approx. 21 hours; Metformin approx. 4-8 hours.

Contraindications

• Severe renal impairment (eGFR less than 30 mL/min/1.73 m²)
• Metabolic acidosis including diabetic ketoacidosis

Precautions

• Use with caution in renal, hepatic, or cardiac impairment; risks of lactic acidosis with metformin, risk of hypoglycemia.

Adverse Reactions - Common

• Hypoglycemia (more common when used with insulin or insulin secretagogues) (Uncommon)
• Gastrointestinal upset (nausea, vomiting, diarrhea) (Common)

Adverse Reactions - Serious

• Lactic acidosis (Rare but serious)
• Pancreatitis (Rare)

Drug-Drug Interactions

• Other antihyperglycemics, especially insulin or sulfonylureas (risk of hypoglycemia)
• Radiographic contrast media (risk of renal impairment and lactic acidosis)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Monitor blood sugar levels regularly.
• Be aware of symptoms of hypoglycemia (shaking, sweating, confusion) and lactic acidosis (weakness, unusual somnolence, abdominal distress).
• Avoid excessive alcohol consumption.
• Maintain hydration and a healthy diet.

Special Considerations

Black Box Warnings:

• Lactic acidosis—risk increased with renal impairment, hepatic impairment, and alcohol use.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Severe hypoglycemia, lactic acidosis.

Treatment: Discontinue medication; supportive care; hemodialysis in case of severe lactic acidosis.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable until the expiration date on the package.