Alogliptin: type 2 diabetes use, dosing, and side effects
Last updated September 7, 2026.
**Alogliptin is a prescription tablet for type 2 diabetes in adults, and it belongs to the DPP-4 inhibitor class (sold as Nesina).** It blocks an enzyme called DPP-4, which lets your own gut hormones stay active longer, so your pancreas releases more insulin after meals and your liver releases less sugar. Because it works mainly when blood sugar is rising, alogliptin by itself rarely causes low blood sugar. The most important safety point is that your dose depends on your kidney function, so you need a blood test of your kidneys before you start and periodically after that.
What does it treat?
Alogliptin treats type 2 diabetes in adults, alongside diet and exercise. It is used when lifestyle changes alone are not holding your A1C at goal, and it is often added to metformin, a sulfonylurea, pioglitazone, or insulin. It is not for type 1 diabetes and it does not treat diabetic ketoacidosis, because those conditions need insulin. It lowers fasting and after-meal glucose gradually, so people usually notice the effect on lab numbers and home glucose readings rather than as a change in how they feel day to day. Combination tablets exist: Kazano pairs alogliptin with metformin, and Oseni pairs alogliptin with pioglitazone. If you take one of those, you are taking alogliptin plus a second drug with its own dosing rules and warnings.
How do you take it?
Alogliptin comes as tablets in 25 mg, 12.5 mg, and 6.25 mg strengths. The usual adult dose is 25 mg once a day, and 25 mg a day is the ceiling. If your creatinine clearance is 30 to under 60 mL/min, the dose drops to 12.5 mg once daily. If it is under 30 mL/min, or you are on dialysis, the dose drops to 6.25 mg once daily, and alogliptin can be taken without regard to the timing of dialysis. Take it with or without food, at about the same time each day. If you miss a dose, take it when you remember that same day, then go back to your normal schedule; if it is almost time for the next dose, skip the missed one and never take two doses at once. Stop taking it and call your doctor right away if you get severe stomach pain that will not let up, yellowing of your eyes or skin, dark urine, a blistering rash, or new swelling and breathlessness. Call your doctor without stopping the drug on your own if your readings run high for several days, if you get repeated low blood sugars, or if you are starting a new prescription that changes your kidney function.
Side effects to know
- Common: Most people tolerate alogliptin well, and the effects reported most often are stuffy or runny nose, sore throat, headache, and upper respiratory infection symptoms.
- Serious: Stop alogliptin and get medical help for signs of pancreatitis (severe ongoing pain in your upper belly that may spread to your back, often with nausea and vomiting), a serious allergic reaction with swelling of the face, lips, or tongue, hives, or peeling or blistering skin, and for signs of liver injury such as yellow eyes or skin, dark urine, or unusual fatigue. Also call the same day for new or worsening heart failure signs (breathlessness lying flat, rapid weight gain, swollen ankles), for severe joint pain, or for tense blisters on your skin, which can be bullous pemphigoid.
Who should not take it?
Do not take alogliptin if you have had a serious allergic reaction to it, including anaphylaxis, angioedema, or a severe skin reaction. Talk with your doctor first if you have kidney disease or are on dialysis, since the dose must be lowered; if you have had pancreatitis, gallstones, or high triglycerides; if you have heart failure; or if you have liver disease. Tell your clinician about every diabetes medicine you take, because insulin and sulfonylureas such as glipizide, glyburide, and glimepiride raise the risk of low blood sugar when alogliptin is added, and their doses often need to come down. Alogliptin has few drug interactions of its own, but if you take the metformin combination, contrast dye for imaging and some diuretics matter. There is not enough human data to know if alogliptin is safe in pregnancy, and most clinicians switch to insulin during pregnancy; it is also not known whether alogliptin passes into breast milk, so discuss feeding plans before you continue it. Alcohol does not react directly with alogliptin, but it can drop your blood sugar hours after drinking, especially on an empty stomach or if you also use insulin or a sulfonylurea, so keep it moderate and eat with it. If you take the metformin combination, heavy drinking also raises the risk of lactic acidosis.
When is it an emergency?
Call 911 in the US for swelling of the lips, tongue, or throat, trouble breathing, a seizure, or if someone cannot be woken. Severe low blood sugar is the emergency to know if you also use insulin or a sulfonylurea: confusion, slurred speech, shaking, sweating, or passing out. If the person is awake and able to swallow, give 15 grams of fast sugar such as juice or glucose tablets and recheck in 15 minutes; if they cannot swallow, use glucagon if you have it and call 911. For too much alogliptin, taken by anyone including a child, call Poison Control at 1-800-222-1222 right away even if the person seems fine. There is no antidote, and treatment is supportive, so early advice matters. Go to an emergency room for severe unrelenting upper abdominal pain with vomiting, which can be pancreatitis, or for sudden severe breathlessness with swollen legs.
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Common questions
What is the maximum dose of alogliptin?
25 mg once a day is the maximum for adults with normal kidney function. Taking more does not lower blood sugar further and is not recommended. If your creatinine clearance is 30 to under 60 mL/min, the maximum drops to 12.5 mg once daily. If it is under 30 mL/min or you are on dialysis, the maximum is 6.25 mg once daily. Your doctor checks kidney function before you start and periodically afterward, because the right ceiling can change over time.
Can I drink alcohol while taking alogliptin?
Alcohol does not interact directly with alogliptin, and moderate drinking with food is generally acceptable. The real issue is blood sugar: alcohol can push glucose down for several hours after you drink, and the symptoms of low blood sugar look a lot like being drunk. That risk is much higher if you also use insulin or a sulfonylurea such as glipizide or glyburide. Eat when you drink, check your glucose before bed, and avoid drinking on an empty stomach. If you take the alogliptin and metformin combination, heavy or binge drinking also raises the risk of lactic acidosis.
Is alogliptin safe during pregnancy or breastfeeding?
There is not enough human data to establish that alogliptin is safe in pregnancy. Most clinicians move pregnant patients to insulin, which has the longest track record for controlling blood sugar during pregnancy. Tell your doctor as soon as you are pregnant or planning to become pregnant so the switch can be planned rather than rushed. It is also not known whether alogliptin passes into human milk, so the decision to continue while breastfeeding is made case by case with your clinician. Do not stop diabetes treatment on your own, because uncontrolled blood sugar carries its own risks for you and the pregnancy.
Do I need to take alogliptin with food?
No. Alogliptin can be taken with or without food, and meals do not meaningfully change how much drug your body absorbs. Pick a time you will remember, such as with breakfast, and keep it consistent. If you take the alogliptin and metformin combination tablet, take it with meals, because that lowers metformin stomach upset. Swallow the tablet whole with water.
What happens if I take too much alogliptin?
Call Poison Control at 1-800-222-1222 right away, even if the person seems fine. There is no specific antidote, so treatment is supportive and may include removing unabsorbed drug from the stomach. Alogliptin alone is unlikely to cause dangerously low blood sugar, but if the extra dose was taken along with insulin or a sulfonylurea, watch for shaking, sweating, confusion, or slurred speech and treat with 15 grams of fast sugar. Call 911 for a seizure, trouble breathing, or someone who cannot be woken. Bring the pill bottle with you if you go in.
Which medicines interact with alogliptin?
Alogliptin has relatively few drug interactions on its own. The important one is with other diabetes medicines: adding it to insulin or a sulfonylurea such as glipizide, glyburide, or glimepiride raises your risk of low blood sugar, and your doctor may cut the dose of those drugs when you start. Do not take alogliptin together with another DPP-4 inhibitor such as sitagliptin, saxagliptin, or linagliptin, since there is no added benefit and duplicate dosing is a common error with combination tablets. Give your clinician a full list including over the counter products, because steroids and some diuretics push blood sugar up while others push it down. If you take the metformin combination, imaging contrast dye needs a plan first.
How long does alogliptin take to work?
It starts working on your after-meal blood sugar within the first days, but the full effect shows up in your A1C, which reflects roughly the last three months. Most clinicians recheck A1C about three months after a dose change. Home glucose readings will usually drift down sooner than that. Keep taking it even if you feel no different, because type 2 diabetes usually causes no symptoms at the glucose levels this drug is treating.