A patient with type 2 diabetes has an eGFR of 30 mL/min/1.73m2. Which of the following antidiabetic drugs can be safely continued in this patient without dose adjustment?

• A Metformin
• B Linagliptin ✓
• C Sitagliptin (standard dose)
• D Glibenclamide

Explanation

Linagliptin is the only DPP-4 inhibitor that is predominantly excreted unchanged in bile/faeces (>80%) with minimal renal excretion, allowing its use at the same dose (5 mg/day) across all stages of CKD including dialysis. Metformin is contraindicated when eGFR <30 (risk of lactic acidosis); sitagliptin requires 75% dose reduction when eGFR 15–30; glibenclamide has active metabolites that accumulate in CKD, causing prolonged hypoglycaemia.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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