Home Drug Guide Alogliptin and Metformin Hydrochloride

Drug Guide

Generic Name

Alogliptin and Metformin Hydrochloride

Brand Names Nesina Met

Classification

Therapeutic: Antidiabetic agent, combination therapy

Pharmacological: Dipeptidyl peptidase-4 (DPP-4) inhibitor and Biguanide

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

Assessment: Monitor blood glucose regularly; assess renal function before and during therapy; watch for signs of lactic acidosis.

Diagnoses:

  • Ineffective tissue perfusion related to hypoglycemia/hyperglycemia
  • Risk of lactic acidosis

Implementation: Administer as prescribed; educate patient on signs of hypoglycemia and lactic acidosis; ensure adequate hydration.

Evaluation: Continual assessment of blood glucose and renal function; monitor for adverse effects.

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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.