Generic Name

Alogliptin benzoate and Metformin hydrochloride

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Classification

FDA Approved Indications

• Management of type 2 diabetes mellitus as an adjunct to diet and exercise

Mechanism of Action

Alogliptin inhibits DPP-4 enzyme, increasing incretin levels which stimulate insulin release and decrease glucagon levels; Metformin reduces hepatic glucose production, decrease intestinal absorption of glucose, and improves insulin sensitivity.

Dosage and Administration

Adult: Typically, 25 mg alogliptin and 1000 mg metformin once daily, adjusted based on glycemic response and tolerability.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution; start at lower doses due to potential renal impairment and comorbidities.

Renal Impairment: Adjust dosage based on renal function; contraindicated if eGFR <30 mL/min/1.73 m².

Hepatic Impairment: Use with caution; contraindicated in severe hepatic impairment.

Pharmacokinetics

Absorption: Alogliptin absorbed with moderate bioavailability; Metformin absorbed slowly from the gastrointestinal tract.

Distribution: Alogliptin protein binding approximately 20%; Metformin minimal protein binding.

Metabolism: Alogliptin undergoes minimal metabolism; Metformin is not metabolized.

Excretion: Primarily renal excretion for both components.

Half Life: Alogliptin approximately 12 hours; Metformin about 5 hours.

Contraindications

• Severe renal impairment (eGFR <30 mL/min/1.73 m²)
• History of hypersensitivity to components

Precautions

• Renal function monitoring; risk of lactic acidosis with metformin; pancreatitis with alogliptin

Adverse Reactions - Common

• nasopharyngitis (common)
• headache (common)
• hypoglycemia (when used with insulin or sulfonylureas) (less common)

Adverse Reactions - Serious

• acute pancreatitis (rare)
• lactic acidosis (due to metformin accumulation) (rare)

Drug-Drug Interactions

• Other antidiabetic drugs increasing hypoglycemia risk
• Cationic drugs affecting renal clearance

Drug-Food Interactions

• Alcohol may increase risk of lactic acidosis

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication as directed, preferably with meals.
• Recognize symptoms of hypoglycemia and lactic acidosis.
• Maintain hydration and regular medical follow-up.

Special Considerations

Black Box Warnings:

• Lactic acidosis, especially in renal impairment or conditions predisposing to hypoxia

Genetic Factors: Genetic variations affecting drug metabolism are not well-established.

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Lactic acidosis, hypoglycemia (if combined with other agents)

Treatment: Discontinue medication; provide supportive care; consider hemodialysis for severe metformin overdose.

Storage and Handling

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

Stability: Stable for the shelf life listed in the package insert.