Gliptins and renal disease

Gliptins and renal disease:

• gliptins, in general, predominately have renal excretion profile. The exception is linagliptin which primarily excreted via bile and gut
  
  
• use in patients with chronic kidney disease (measured units are in terms of creatinine clearance [CrCl])
  • sitagliptin
    • for patients with mild renal impairment (CrCl>= 50 ml/min), no dose adjustment is required
    • for patients with moderate renal impairment (CrCl >=30 and CrCl<50 mL/min), the dose of sitagliptin is 50 mg once daily
    • for patients with severe renal impairment (CrCl <30 mL/min) or with end-stage renal disease (ESRD) requiring haemodialysis or peritoneal dialysis, the dose of sitagliptin is 25 mg once daily
      
      
  • saxagliptin
    • no dose adjustment is recommended for patients with mild renal impairment
    • dose of saxagliptin should be reduced to 2.5 mg once daily in patients with moderate or severe renal impairment
    • experience in patients with severe renal impairment is very limited. Therefore, saxagliptin should be used with caution in this population
    • not recommended for patients with end-stage renal disease (ESRD) requiring haemodialysis
      
      
  • vildagliptin
    • no dose adjustment is required in patients with mild renal impairment (CrCl>50 ml/min)
    • with moderate or severe renal impairment or with end-stage renal disease (ESRD), the recommended dose of vildagliptin is 50 mg once daily
      
      
  • linagliptin
    • no dose adjustment is required in patients with renal disease

For up to date details before prescribing a gliptin in renal impairment/disease then consult the relevant summary of product characteristics (SPCs)

Reference:

• SPCs for sitagliptin, saxagliptin, vildagliptin, linagliptin (electronic Medicines Compendium (eMC)) (July 2012)