Antidiabetic drugs: DPP-4 inhibitors in renal failure: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antidiabetic drugs: DPP-4 inhibitors in renal failure

Sample item

A 78-year-old man with type 2 diabetes, eGFR 20 mL/min and HbA1c 8.4% has had metformin stopped. A DPP-4 inhibitor that needs no renal dose reduction is wanted. Which drug is most suitable?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Linagliptin

Most gliptins are renally cleared and need dose reduction when eGFR falls below 45 or 30 mL/min. Linagliptin is eliminated mainly through bile and the gut, so the dose does not change in renal impairment. This, with a low hypoglycaemia risk, makes it useful in elderly patients with CKD.

Option by option

  • A. Saxagliptin

    Saxagliptin requires dose reduction in severe renal impairment.

  • B. Vildagliptin

    Vildagliptin dosing is reduced in moderate to severe renal impairment.

  • C. Linagliptin (correct)

    Correct. Linagliptin is excreted mainly through the enterohepatic route and needs no renal adjustment.

  • D. Sitagliptin

    Sitagliptin is mainly renally excreted and its dose is reduced in severe renal impairment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Linagliptin. Most gliptins are renally cleared and need dose reduction when eGFR falls below 45 or 30 mL/min.

Why is "Saxagliptin" not the answer?

Saxagliptin requires dose reduction in severe renal impairment.

Why is "Vildagliptin" not the answer?

Vildagliptin dosing is reduced in moderate to severe renal impairment.

Why is "Sitagliptin" not the answer?

Sitagliptin is mainly renally excreted and its dose is reduced in severe renal impairment.

What concept does this question test?

It tests Antidiabetic drugs: DPP-4 inhibitors in renal failure in Pharmacology. Linagliptin is eliminated mainly through bile and the gut, so the dose does not change in renal impairment. This, with a low hypoglycaemia risk, makes it useful in elderly patients with CKD.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antidiabetic drugs: DPP-4 inhibitors in renal failure?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.