Vipidia (Alogliptin)
DPP-4 inhibitor for blood sugar control in type 2 diabetes
Vipidia (alogliptin) is a prescription oral antidiabetic medication belonging to the DPP-4 inhibitor class (dipeptidyl peptidase-4 inhibitors). It is used in adults with type 2 diabetes mellitus to improve blood sugar control when diet, exercise, and other diabetes medications do not provide adequate glycemic management. Vipidia works by increasing insulin levels after meals while reducing glucagon, helping the body regulate blood sugar more effectively.
Quick Facts
Key Takeaways
- Vipidia (alogliptin) is an oral DPP-4 inhibitor taken once daily to help control blood sugar in adults with type 2 diabetes.
- It is always used in combination with other diabetes medications such as metformin, sulfonylureas, thiazolidinediones, or insulin.
- The standard dose is 25 mg daily, with reduced doses (12.5 mg or 6.25 mg) for patients with impaired kidney function.
- Serious but rare side effects include pancreatitis and severe allergic reactions (Stevens-Johnson syndrome); seek immediate medical attention if symptoms occur.
- Vipidia is not recommended for use during pregnancy or breastfeeding, and is not approved for children under 18 years of age.
What Is Vipidia and What Is It Used For?
Vipidia is the brand name for the active substance alogliptin, which belongs to a group of medicines called DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors). These are a widely used class of oral antidiabetic medications designed specifically for the management of type 2 diabetes mellitus, also known as non-insulin-dependent diabetes. Type 2 diabetes is a chronic metabolic condition in which the body does not produce enough insulin or cannot use insulin effectively, resulting in elevated blood sugar levels that, if left uncontrolled, can lead to serious complications affecting the heart, kidneys, eyes, and nerves.
Alogliptin works by inhibiting the enzyme DPP-4, which is responsible for breaking down incretin hormones—principally glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). These hormones are naturally released from the gut after eating and play a critical role in regulating blood sugar. By blocking DPP-4, alogliptin allows incretin levels to remain elevated for longer, which stimulates the pancreas to release more insulin and simultaneously reduces the release of glucagon (a hormone that raises blood sugar). Importantly, this insulin-stimulating effect is glucose-dependent, meaning it primarily occurs when blood sugar levels are elevated, which contributes to a lower risk of hypoglycemia compared to some other diabetes medications.
Vipidia is prescribed as an add-on therapy, meaning it is always used together with one or more other diabetes medications. It may be combined with:
- Metformin – the most commonly prescribed first-line diabetes medication
- Sulfonylureas (e.g., glipizide, tolbutamide, glibenclamide) – medications that stimulate insulin release
- Thiazolidinediones (e.g., pioglitazone) – medications that improve insulin sensitivity
- Insulin – when additional glycemic control is needed
- Combination regimens involving metformin plus a thiazolidinedione
Clinical trials have demonstrated that alogliptin, when added to existing therapy, reduces HbA1c (glycated hemoglobin) by approximately 0.5–0.7 percentage points, a clinically meaningful improvement in long-term blood sugar control. The EXAMINE trial, a major cardiovascular outcomes study involving over 5,000 patients, confirmed that alogliptin does not increase the risk of major adverse cardiovascular events in patients with type 2 diabetes and recent acute coronary syndrome, providing important reassurance about its cardiovascular safety profile.
It is essential that patients continue to follow dietary and exercise recommendations provided by their healthcare team while taking Vipidia. The medication does not replace a healthy lifestyle but works alongside it to achieve optimal blood sugar control and reduce the risk of diabetes-related complications.
What Should You Know Before Taking Vipidia?
Contraindications
Vipidia should not be taken in the following circumstances:
- Allergy to alogliptin or any of the other ingredients in the medication (including mannitol, microcrystalline cellulose, hydroxypropylcellulose, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, iron oxides, macrogol 8000, shellac, and black iron oxide).
- Previous serious allergic reaction to any DPP-4 inhibitor (such as sitagliptin, saxagliptin, linagliptin, or vildagliptin). Symptoms of serious allergic reactions include rash, raised red patches on the skin (hives), swelling of the face, lips, tongue and throat that may cause difficulty breathing or swallowing, and generalized itching with a sensation of heat, particularly affecting the scalp, mouth, throat, palms, and soles of feet (Stevens-Johnson syndrome).
- Type 1 diabetes (where the body does not produce insulin). Vipidia is designed only for type 2 diabetes and will not be effective in type 1 diabetes.
- Diabetic ketoacidosis (a serious complication of diabetes that occurs when the body cannot break down glucose due to insufficient insulin). Symptoms include excessive thirst, frequent urination, loss of appetite, nausea or vomiting, and rapid weight loss.
Warnings and Precautions
Talk to your doctor or pharmacist before taking Vipidia if any of the following apply to you:
Rare cases of pancreatitis (inflammation of the pancreas) have been reported with DPP-4 inhibitors, including alogliptin. If you experience severe and persistent abdominal pain that may radiate to the back, accompanied by nausea and vomiting, seek immediate medical attention. Your doctor will discontinue Vipidia if pancreatitis is suspected or confirmed.
- Kidney disease: You may still take Vipidia, but your doctor may need to reduce the dose. For moderate kidney impairment (creatinine clearance 30–60 mL/min), the recommended dose is 12.5 mg once daily. For severe kidney impairment (creatinine clearance less than 30 mL/min) or end-stage renal disease requiring dialysis, the dose is 6.25 mg once daily.
- Liver disease: Vipidia can be used in patients with mild to moderate liver impairment at the standard dose of 25 mg daily. However, it is not recommended for patients with severe liver impairment due to insufficient clinical data in this population.
- Heart failure: Experience with Vipidia is limited in patients with New York Heart Association (NYHA) Class III–IV heart failure. Use with caution and under close medical supervision in these patients.
- Concurrent sulfonylurea or insulin use: When Vipidia is taken together with a sulfonylurea or insulin, the risk of hypoglycemia (low blood sugar) increases. Your doctor may reduce the dose of the sulfonylurea or insulin to minimize this risk.
- History of pancreatitis: Patients with a previous history of pancreatic disease should use Vipidia with caution and under medical supervision.
- Bullous pemfigoid: Contact your doctor if you develop blisters on the skin, as this may be a sign of a condition called bullous pemfigoid. Your doctor may advise you to stop taking alogliptin.
Drug Interactions
Tell your doctor or pharmacist about all medications you are currently taking, have recently taken, or might take. While alogliptin has a relatively low potential for drug interactions compared to some other diabetes medications, certain combinations require monitoring or dose adjustments. Alogliptin is primarily excreted by the kidneys and has minimal interaction with the cytochrome P450 enzyme system, which reduces the likelihood of pharmacokinetic interactions with most other drugs.
However, the following interactions are clinically important:
| Interacting Drug | Effect | Action Required |
|---|---|---|
| Sulfonylureas (glipizide, glibenclamide, tolbutamide) | Increased risk of hypoglycemia | Doctor may reduce sulfonylurea dose |
| Insulin (all types) | Increased risk of hypoglycemia | Doctor may reduce insulin dose |
| Metformin | No clinically significant interaction | Standard doses; commonly used together |
| Pioglitazone | No clinically significant interaction | Standard doses; commonly used together |
| Warfarin | No clinically significant interaction | No dose adjustment needed |
| ACE inhibitors | Possible increased risk of angioedema | Monitor for swelling of face, lips, throat |
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
There is no clinical experience with the use of Vipidia in pregnant or breastfeeding women. Animal studies do not indicate direct or indirect harmful effects on fertility, pregnancy, embryo-fetal development, or postnatal development at clinically relevant doses. However, as a precautionary measure, Vipidia should not be used during pregnancy. Your doctor will help you decide whether to continue breastfeeding or to start or continue using Vipidia, as it is not known whether alogliptin is excreted in human breast milk.
Women of childbearing age who have type 2 diabetes should discuss appropriate contraception and alternative diabetes treatments with their healthcare provider if pregnancy is planned or occurs during treatment.
Children and Adolescents
Vipidia is not recommended for children and adolescents under 18 years of age. Clinical studies in pediatric patients did not demonstrate sufficient efficacy to support its use in this population. Alternative diabetes treatments should be considered for young patients with type 2 diabetes.
Driving and Operating Machinery
Vipidia has no known effect on the ability to drive and use machines when taken alone or with metformin. However, when Vipidia is used in combination with a sulfonylurea, insulin, or a combination regimen including a thiazolidinedione and metformin, there is a risk of hypoglycemia, which can cause dizziness, visual disturbances, and impaired concentration. If you experience symptoms of low blood sugar, do not drive or operate machinery until these symptoms resolve.
Vipidia contains less than 1 mmol (23 mg) sodium per tablet, making it essentially sodium-free. This is relevant for patients on sodium-restricted diets.
What Is the Correct Dosage of Vipidia?
Always take Vipidia exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Your doctor will prescribe Vipidia together with one or more other medications to control your blood sugar levels and will advise you if you need to change the dose of any of your other medicines.
Adults with Normal Kidney Function
Standard Adult Dose
25 mg alogliptin taken once daily. Swallow the tablet whole with water. Vipidia can be taken with or without food at any time of day, although taking it at the same time each day helps maintain consistent blood levels and improves adherence.
Patients with Kidney Disease
If you have kidney disease, your doctor will prescribe a lower dose based on how well your kidneys are functioning. Kidney function is typically assessed using estimated glomerular filtration rate (eGFR) or creatinine clearance measurements.
| Kidney Function | Creatinine Clearance | Recommended Dose |
|---|---|---|
| Normal / Mild impairment | ≥ 60 mL/min | 25 mg once daily |
| Moderate impairment | 30–60 mL/min | 12.5 mg once daily |
| Severe impairment / ESRD | < 30 mL/min (incl. dialysis) | 6.25 mg once daily |
Alogliptin may be administered without regard to the timing of dialysis. Approximately 7% of the drug is removed during a 3-hour hemodialysis session.
Patients with Liver Disease
No dose adjustment is required for patients with mild to moderate liver impairment (Child-Pugh classification A or B). The standard dose of 25 mg once daily can be used. Vipidia has not been studied in patients with severe liver impairment (Child-Pugh C) and is therefore not recommended for use in these patients.
Elderly Patients
No dose adjustment is needed based on age alone. However, elderly patients are more likely to have reduced kidney function, and the dose should be adjusted according to kidney function as described above. Regular monitoring of kidney function is recommended in elderly patients taking Vipidia.
If You Miss a Dose
If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the usual time. Do not take a double dose to make up for a missed dose. If you are unsure about what to do, consult your doctor or pharmacist.
Overdose
If you take more Vipidia than you should, or if a child swallows the medication, contact your doctor or nearest emergency department immediately. Bring this information and any remaining tablets so that the medical team knows exactly what has been taken. In clinical studies, single doses up to 800 mg in healthy subjects were generally well tolerated, but medical evaluation is still recommended after any overdose.
If You Stop Taking Vipidia
Do not stop taking Vipidia without consulting your doctor first. Your blood sugar levels may increase when you stop taking Vipidia, which can lead to worsening diabetes control and increase the risk of long-term complications. If you experience side effects or have concerns about your medication, discuss alternatives with your doctor rather than stopping treatment abruptly.
How Does Vipidia Interact with Other Drugs?
Alogliptin has a favorable pharmacokinetic profile with respect to drug interactions. It does not significantly inhibit or induce cytochrome P450 (CYP) enzymes at clinically relevant concentrations, which means it has a low potential for altering the metabolism of other medications. Additionally, alogliptin has low plasma protein binding (approximately 20%), further reducing the likelihood of displacement interactions.
Major Interactions
The most clinically significant interactions with Vipidia involve other blood sugar-lowering medications:
- Sulfonylureas (glipizide, glibenclamide, tolbutamide, glimepiride): Combining Vipidia with a sulfonylurea substantially increases the risk of hypoglycemia. In clinical trials, the incidence of hypoglycemia was approximately 3–4 times higher when alogliptin was combined with a sulfonylurea compared to sulfonylurea alone. Your doctor should consider reducing the sulfonylurea dose when starting Vipidia to minimize this risk.
- Insulin: Similar to sulfonylureas, adding Vipidia to an insulin regimen increases the risk of hypoglycemia. An insulin dose reduction may be necessary when initiating Vipidia therapy.
- ACE inhibitors (e.g., enalapril, lisinopril, ramipril): There have been post-marketing reports of angioedema in patients taking DPP-4 inhibitors concomitantly with ACE inhibitors. While the mechanism is not fully understood, both drug classes can affect bradykinin metabolism, potentially increasing the risk of angioedema. Patients should be monitored for signs of swelling of the face, lips, tongue, or throat.
Minor or No Significant Interactions
The following medications have been studied with alogliptin and no clinically meaningful interactions were found:
- Metformin: No pharmacokinetic interaction. This is one of the most common and effective combination therapies for type 2 diabetes. A fixed-dose combination tablet (alogliptin/metformin, marketed as Vipdomet) is also available.
- Pioglitazone: No significant interaction. A fixed-dose combination (alogliptin/pioglitazone, marketed as Incresync) is available.
- Warfarin: No effect on warfarin pharmacokinetics or international normalized ratio (INR). No dose adjustment required.
- Cimetidine: No clinically significant effect on alogliptin exposure.
- Digoxin: No clinically meaningful interaction observed.
- Cyclosporine: Studies show no significant effect on alogliptin pharmacokinetics, though this combination should still be used with appropriate clinical monitoring.
- Atorvastatin: No significant pharmacokinetic interaction.
- Ethinyl estradiol/norethisterone: No effect on the pharmacokinetics of oral contraceptives.
Despite the favorable interaction profile, patients should always inform their healthcare provider about all prescription medications, over-the-counter drugs, herbal products, and dietary supplements they are taking before starting Vipidia.
What Are the Side Effects of Vipidia?
Like all medicines, Vipidia can cause side effects, although not everybody gets them. The following side effects have been reported during clinical trials and post-marketing surveillance. The frequency categories follow the standard medical classification used by the European Medicines Agency (EMA).
- Allergic reaction: rash, hives, difficulty swallowing or breathing, swelling of lips, face, throat or tongue, feeling faint
- Severe allergic skin reaction: skin lesions or spots that may progress to blisters surrounded by pale or red rings (Stevens-Johnson syndrome or erythema multiforme)
- Severe and persistent abdominal pain, possibly radiating to the back, with nausea and vomiting (possible pancreatitis)
Common Side Effects
May affect up to 1 in 10 people
- Hypoglycemia (low blood sugar) – when taken with a sulfonylurea or insulin. Symptoms include trembling, sweating, anxiety, blurred vision, tingling in the lips, paleness, mood changes, or confusion
- Cold-like symptoms (upper respiratory tract infection) – sore throat, nasal congestion, runny nose
- Skin rash
- Skin itching (pruritus)
- Headache
- Stomach pain (abdominal pain)
- Diarrhea
- Indigestion (dyspepsia) and heartburn (gastroesophageal reflux)
Frequency Not Known
Cannot be estimated from available data
- Allergic reactions – rash, hives, swallowing or breathing problems, swelling of lips, face, throat or tongue, feeling faint
- Severe allergic skin reactions – Stevens-Johnson syndrome and erythema multiforme (skin lesions, blisters, fever, joint pain, painful or itchy eyes, mouth sores)
- Pancreatitis – severe and persistent abdominal pain possibly radiating to the back, nausea and vomiting
- Liver problems – nausea or vomiting, stomach pain, unusual or unexplained tiredness, loss of appetite, dark urine, yellowing of skin or whites of eyes (jaundice)
- Interstitial nephritis – inflammation of connective tissue in the kidneys
- Bullous pemfigoid – blisters on the skin
Managing Hypoglycemia
Hypoglycemia is the most commonly reported side effect when Vipidia is used in combination with sulfonylureas or insulin. The risk of hypoglycemia is low when Vipidia is used with metformin alone or as monotherapy. If you experience symptoms of low blood sugar (trembling, sweating, anxiety, blurred vision, tingling in the lips, paleness, confusion), you can raise your blood sugar by consuming fast-acting glucose sources such as sugar tablets, candy, biscuits, or sugar-containing fruit juice. It is recommended that you carry some form of fast-acting sugar with you at all times.
If hypoglycemia is recurrent, talk to your doctor. A dose reduction of the sulfonylurea or insulin may be needed to prevent further episodes.
Reporting Side Effects
Reporting suspected adverse reactions after authorization of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicine. Healthcare professionals and patients are encouraged to report side effects to their national pharmacovigilance authority (e.g., the FDA MedWatch program in the United States, the Yellow Card Scheme in the United Kingdom, or the EMA EudraVigilance system in Europe).
How Should You Store Vipidia?
Proper storage of Vipidia is important to ensure the medication remains effective and safe throughout its shelf life. Follow these storage guidelines:
- Keep out of sight and reach of children. Store the medication in a safe location where children cannot access it.
- Check the expiry date. Do not use Vipidia after the expiry date stated on the carton and blister after “EXP”. The expiry date refers to the last day of that month.
- No special storage conditions. Vipidia does not require any specific temperature or humidity conditions. Store at normal room temperature, away from excessive heat and moisture.
- Keep in original packaging. The blister packaging provides protection from light and moisture. Do not remove tablets from the blister until ready to take them.
- Proper disposal. Do not dispose of medications via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment.
What Does Vipidia Contain?
Active Ingredient
The active substance is alogliptin, provided as alogliptin benzoate. Alogliptin is a potent, highly selective inhibitor of the DPP-4 enzyme with an IC50 of approximately 6.9 nM. It demonstrates greater than 10,000-fold selectivity for DPP-4 over other related enzymes such as DPP-8 and DPP-9, which contributes to its favorable tolerability profile.
Inactive Ingredients (Excipients)
The non-active ingredients include:
- Tablet core: Mannitol, microcrystalline cellulose, hydroxypropylcellulose, croscarmellose sodium, magnesium stearate
- Film coating: Hypromellose, titanium dioxide (E 171), iron oxide (E 172 – red for 25 mg and 6.25 mg; yellow for 12.5 mg), macrogol 8000, shellac, black iron oxide (E 172)
Tablet Appearance
| Strength | Color | Shape & Size | Imprint |
|---|---|---|---|
| 25 mg | Light red | Oval, biconvex (~9.1 mm × 5.1 mm) | “TAK” and “ALG-25” in grey ink |
| 12.5 mg | Yellow | Oval, biconvex (~9.1 mm × 5.1 mm) | “TAK” and “ALG-12.5” in grey ink |
| 6.25 mg | Light pink | Oval, biconvex (~9.1 mm × 5.1 mm) | “TAK” and “ALG-6.25” in grey ink |
Vipidia is available in blister packs containing 10, 14, 28, 30, 56, 60, 84, 90, 98, or 100 tablets. Not all pack sizes may be marketed in every country.
Marketing Authorization Holder
Takeda Pharma A/S, Delta Park 45, 2665 Vallensbaek Strand, Denmark. The product is manufactured by Takeda Ireland Limited, Bray Business Park, Kilruddery, Co. Wicklow, Ireland. Vipidia was first authorized in the European Union in September 2013 and is also marketed under the brand name Nesina in the United States and certain other markets.
Frequently Asked Questions About Vipidia
References
All medical information is based on peer-reviewed research, international guidelines, and regulatory sources. Evidence Level 1A.
- European Medicines Agency (EMA). Vipidia (alogliptin) – Summary of Product Characteristics. Last updated 2023. Available at: ema.europa.eu/vipidia
- White WB, Cannon CP, Heller SR, et al. Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes (EXAMINE Trial). N Engl J Med. 2013;369(14):1327-1335. doi:10.1056/NEJMoa1305889
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes – 2024. Diabetes Care. 2024;47(Suppl 1):S1–S321.
- Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022: A Consensus Report by the ADA and EASD. Diabetes Care. 2022;45(11):2753–2786. doi:10.2337/dci22-0034
- U.S. Food and Drug Administration (FDA). Nesina (alogliptin) Prescribing Information. Takeda Pharmaceuticals America, Inc. Revised 2023.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: World Health Organization; 2023.
- Pratley RE, Reusch JEB, Fleck PR, et al. Efficacy and safety of the DPP-4 inhibitor alogliptin added to metformin therapy in patients with type 2 diabetes. Curr Med Res Opin. 2009;25(10):2361–2371.
- Nauck MA, Meininger G, Sheng D, et al. Efficacy and safety of the DPP-4 inhibitor alogliptin in patients inadequately controlled with metformin and pioglitazone. Diabetes Care. 2009;32(7):1224–1230.
Medical Editorial Team
This article has been reviewed by licensed physicians with expertise in endocrinology, clinical pharmacology, and internal medicine.
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