Agent | Brand name | Dose | Half-life (h) | Elimination | Renal insufficiency* |
---|---|---|---|---|---|
GLP-1 receptor agonists | |||||
Short-acting | |||||
Exenatide twice daily | Byetta | Subcutaneous 5–10 μg BID | 2.4 | Renal, proteolytic degradation | Moderate: caution Severe: NR |
Lixisenatide | Lyxumia | Subcutaneous 10 μg once daily | 3.0 | Renal, metabolic degradation | Moderate: caution Severe: NR |
Long-acting | |||||
Albiglutide | Eperzan Tanzeum | Subcutaneous 30–50 mg once weekly | 86.4–163.2 | Proteolytic degradation | NR |
Dulaglutide | Trulicity | Subcutaneous 0.75–1.5 mg once weekly | 112 | Proteolytic degradation | Moderate: caution Severe: NR |
Exenatide once weekly | Bydureon | Subcutaneous 2 mg once weekly | 2.4† | Renal, proteolytic degradation | NR |
Liraglutide | Victoza | Subcutaneous 1.2–1.8 mg once daily | 13.0 | Generalised proteolysis; Elimination: renal (6%); faecal (5%) | Moderate: caution Severe: NR |
DPP-4 inhibitors | |||||
Alogliptin | Nesina Vipidia | Oral 25 mg once daily | 12.5–21.1 | Renal (>70% unchanged) | Dose reduction |
Linagliptin | Trajenta | Oral 5 mg once daily | 10.0–40.0 | Renal (5%); faecal (95%) | No adjustment |
Saxagliptin | Onglyza | Oral 5 mg once daily | 2.2–3.8 | Metabolised to active metabolite, renal elimination (12–29% unchanged, 21–52% metabolite) | Dose reduction |
Sitagliptin | Januvia | Oral 100 mg once daily | 8.0–24.0 | Renal (80% unchanged) | Dose reduction |
Vildagliptin | Galvus Zomelis Jalra | Oral 50 mg twice daily (or 50 mg once daily plus sulfonylurea) | 1.5–4.5 | Metabolised to inactive metabolite, renal excretion (22% unchanged) | Dose reduction |
All data is based on the products’ summary of product characteristics.
*Moderate and severe renal insufficiency are defined as an estimated glomerular filtration rate of 30–59 mL/min/1.73 m2 and <30 mL/min/1.73 m2, respectively.
†Exenatide once weekly is similar to exenatide twice daily, except for a slower absorption from the subcutaneous space with the once weekly formulation.
DPP-4, dipeptidyl peptidase 4; GLP-1, glucagon-like peptide 1; NR, not recommended.