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Clinician’s Corner: DPP4  INHIBITORS

DPP4  INHIBITORS— not very potent and very expensive!

Incretins that we naturally produce blunt glucagon release (which raises blood sugars)  and stimulate insulin release when blood sugars are elevated.  Incretins, released in response to a meal, also slow digestion and promote a feeling of fullness. We have an enzyme called DPP4- (dipeptidyl peptidase) which breaks down the incretins our body produces.  These drugs block DPP4 and cause increases in the concentrations of incetrins

  • Levels of incretins decrease over time in diabetics, consequently, these DPP-4 inhibitors would be expected to be of most benefit in early Type-2 diabetes.
  • Better at reducing after meal glucose levels than fasting levels
  • Will be mostly used as an “add-on” drug.  Lowers HbA1C by only 0.6-0.8%
    • Most feel their price (Januvia cost $460. 00/month) isn’t worth the minimal HbA1c lowering
    • Only Nesina (alogliptin) is available as a generic.  Is still in short supply and cost is over $200.00

REPRESENTATIVE PRODUCTS

  • Januvia  (sitagliptin)  by Merck              October-2006
  • Onglyza® (saxagliptin) by Astra Zeneca      July-2009
  • Tradjenta ((linagliptin)  by Eli Lilly           June-2011
  • Nesina (alogliptin)   (by Takeda)               Jan-2013

Your Thompson Pharmacist and providers are aware treating diabetes is an expensive proposition.  The DPP-4 inhibitors are not of much value, seeing that we are lucky to lower HbA1c by even 1%.  Their effectiveness does not justify their cost.  They are weight neutral, which is one of the few positive aspects of this class of drugs.

Always ask your Thompson Pharmacist about any of your drug therapy, the best time to take your medications and side effects.  Go ahead and AS… at Thompson Pharmacy it’s all for YOU!