Teneligliptin Dosing Considerations in Renal Impairment

Dosing Requirements for Alternative DPP-4 Inhibitors

The American Diabetes Association recommends sitagliptin dose reduction when eGFR <45 mL/min/1.73 m² (100 mg daily if eGFR ≥45; 50 mg daily if eGFR 30-44; 25 mg daily if eGFR <30) 1, 2
The National Kidney Foundation suggests saxagliptin dose reduction when eGFR ≤45 mL/min/1.73 m² (maximum 2.5 mg daily) 1, 2
The American College of Cardiology indicates alogliptin requires dose adjustment based on renal function (25 mg if eGFR >60; 12.5 mg if eGFR 30-60; 6.25 mg if eGFR <30) 1, 2

The American Heart Association advises that DPP-4 inhibitors, including teneligliptin, should not be first-line therapy for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease with albuminuria—in these populations, GLP-1 receptor agonists or SGLT2 inhibitors are preferred due to proven cardiovascular and renal benefits 1, 2
The European Association for the Study of Diabetes recommends discontinuing DPP-4 inhibitors if pancreatitis is suspected, although causality has not been established 1

The American Diabetes Association recommends assessing glycemic control (HbA1c) every 3 months to determine treatment efficacy 1
The National Kidney Foundation suggests monitoring renal function periodically as part of routine diabetes care, but this does not necessitate dose changes for teneligliptin 1

The American Diabetes Association and the National Kidney Foundation suggest that teneligliptin maintains a favorable safety profile across all stages of kidney disease, with no new adverse events emerging in patients with impaired renal function 3, 4

The Endocrine Society recommends that while most DPP-4 inhibitors require dose adjustment in advanced CKD, teneligliptin is one of the few that does not, unlike sitagliptin, saxagliptin, and alogliptin which require dose reduction in patients with eGFR <30 ml/min/1.73 m², eGFR ≤45 ml/min/1.73 m², and eGFR <30 ml/min/1.73 m² respectively 3, 5
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines indicate that linagliptin, similar to teneligliptin, does not require dose adjustment in patients with impaired renal function 3

The American Diabetes Association and the National Kidney Foundation recommend considering the dose adjustment requirements for DPP-4 inhibitors in patients with renal impairment, with teneligliptin and linagliptin being exceptions that do not require dose adjustment across all stages of renal impairment 6
Sitagliptin requires a dose reduction to 50 mg daily when eGFR is 30-44 mL/min/1.73 m² and 25 mg daily when eGFR is <30 mL/min/1.73 m², as recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline 6
Saxagliptin requires a dose reduction to a maximum of 2.5 mg daily when eGFR is ≤45 mL/min/1.73 m², according to the American College of Cardiology recommendations 6
Alogliptin requires a dose reduction to 12.5 mg daily when eGFR is 30-60 mL/min/1.73 m² and 6.25 mg daily when eGFR is <30 mL/min/1.73 m², as suggested by the European Association for the Study of Diabetes (EASD) guidelines 6
Linagliptin, like teneligliptin, requires no dose adjustment across all stages of renal impairment, as stated by the International Society of Nephrology (ISN) 6

The European Society of Cardiology recommends that DPP-4 inhibitors, including teneligliptin, should not be first-line therapy for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease with albuminuria, due to the lack of proven cardiovascular and renal benefits 6
In these high-risk populations, GLP-1 receptor agonists or SGLT2 inhibitors are strongly preferred due to their proven cardiovascular and renal benefits, as recommended by the American Heart Association (AHA) 6