Incresync (Pioglitazone, Alogliptin)

Incresync combines a thiazolidinedione and a DPP‑4 inhibitor to improve glycaemic control in type 2 diabetes.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose when added to diet and exercise.
• Inadequate control on monotherapy: provides additional glucose‑lowering effect as part of combination therapy.
• Adults requiring improved insulin sensitivity: enhances peripheral insulin action while augmenting incretin‑mediated insulin secretion.

• Pioglitazone binds to and activates the nuclear peroxisome proliferator‑activated receptor‑γ (PPARγ), modulating gene expression to increase peripheral insulin sensitivity and glucose uptake. Alogliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), preventing degradation of the incretin hormones GLP‑1 and GIP, thereby prolonging their action to stimulate glucose‑dependent insulin secretion and suppress glucagon release. The dual action addresses both insulin resistance and impaired insulin secretion.

Incresync may be associated with a range of adverse reactions, which are reported in clinical use.

Common Side Effects

• Edema: swelling of the lower extremities.
• Weight gain: modest increase in body weight.
• Upper respiratory tract infection: symptoms such as cough or sore throat.
• Headache: mild to moderate intensity.
• Nausea: occasional stomach discomfort.

Serious or Rare Side Effects

• Congestive heart failure exacerbation: worsening of pre‑existing heart failure.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Severe hypoglycaemia: especially when combined with insulin or sulfonylureas.
• Pancreatitis: acute inflammation of the pancreas.
• Bone fracture: increased risk of femoral fractures in susceptible patients.

When prescribing Incresync, clinicians should consider several precautionary measures to minimise risk.

• Liver function monitoring: assess hepatic enzymes before initiation and periodically during therapy.
• Heart failure assessment: avoid in patients with active or uncontrolled congestive heart failure.
• Edema evaluation: monitor for peripheral swelling, particularly in the ankles.
• Bladder cancer history: use with caution in patients with a history of bladder carcinoma.
• Renal function: adjust use in moderate renal impairment and monitor creatinine.
• Pregnancy and lactation: safety not established; avoid unless benefits outweigh potential risks.
• Store at ambient temperature: keep tablets in the original container, protect from moisture and heat.

Incresync can interact with other medicines, influencing its efficacy or safety.

Major Interactions (Avoid)

• Concomitant insulin or sulfonylureas: increased risk of hypoglycaemia.
• Strong CYP2C8 inhibitors (e.g., gemfibrozil): raise pioglitazone plasma concentrations.
• Co‑administration with another DPP‑4 inhibitor: additive inhibition of DPP‑4, not recommended.

Moderate Interactions (Monitor Closely)

• Diuretics: may mask pioglitazone‑induced fluid retention.
• ACE inhibitors or ARBs: monitor renal function and electrolytes.
• Warfarin: possible alteration of INR, requiring closer coagulation monitoring.
• NSAIDs: may increase risk of renal impairment when combined.