Drug Class Guide
DPP-4 Inhibitors (Gliptins)
Well-tolerated diabetes pills that lower blood sugar modestly, with little risk of low blood sugar or weight gain.
How DPP-4 Inhibitors Work
After a meal, the gut releases incretin hormones such as GLP-1 that tell the pancreas to release insulin and hold back glucagon. The enzyme DPP-4 breaks those hormones down within minutes. Blocking DPP-4 lets them last longer, so blood sugar after meals comes down.
What DPP-4 Inhibitors Treat
DPP-4 Inhibitors in Our Medication Guide
- SitagliptinJanuviaThe most widely used; the dose is adjusted for kidney function.
- LinagliptinTradjentaNo dose adjustment needed for kidney disease.
- SaxagliptinOnglyzaLinked to more heart failure hospitalizations in a large trial.
- AlogliptinNesinaDose adjusted for kidney function; also carries a heart failure warning.
Common Side Effects
Most people notice no side effects. Some have a stuffy nose, sore throat or headache. Used alone, they rarely cause low blood sugar; the risk rises when they are combined with a sulfonylurea or insulin.
Important Cautions
- Rare cases of pancreatitis have been reported; severe belly pain that spreads to the back needs prompt care.
- FDA has warned about severe joint pain and a blistering skin condition (bullous pemphigoid) with this class.
- Saxagliptin and alogliptin may raise the risk of heart failure in people with heart or kidney disease.
Common Questions About DPP-4 Inhibitors
What is the difference between a DPP-4 inhibitor and a GLP-1 medication?
Both work through the GLP-1 hormone system, but GLP-1 medications such as semaglutide supply a much stronger signal. They lower A1c more and cause substantial weight loss; DPP-4 pills lower A1c modestly and do not change weight. They are not taken together.
Do DPP-4 inhibitors cause low blood sugar?
Rarely on their own, because they only boost insulin when blood sugar is elevated. Low blood sugar becomes more likely if they are taken with a sulfonylurea such as glipizide or with insulin, which may need a lower dose.
Can I take a DPP-4 inhibitor with kidney disease?
Yes. Linagliptin needs no dose change, while sitagliptin, saxagliptin and alogliptin are given at lower doses as kidney function declines. Your doctor will base the dose on your kidney blood tests.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for DPP-4 Inhibitors
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