Alogliptin and Risk of Urinary Tract Infections
Alogliptin does not significantly increase the risk of urinary tract infections (UTIs) compared to other antidiabetic medications. 1
Evidence on DPP-4 Inhibitors and UTI Risk
The 2025 American Diabetes Association (ADA) Standards of Care provides the most recent and authoritative guidance on DPP-4 inhibitors, including alogliptin. The guidelines do not list UTIs as a safety concern for DPP-4 inhibitors 1. In the comprehensive table of antidiabetic medications and their side effects, UTIs are notably absent from the safety profile of DPP-4 inhibitors, while they are specifically mentioned as concerns for other medication classes such as SGLT2 inhibitors.
The safety concerns listed for DPP-4 inhibitors include:
- Pancreatitis (reported but causality not established)
- Postmarketing reports of arthralgia and bullous pemphigoid 1
In contrast, SGLT2 inhibitors are clearly associated with an increased risk of genitourinary infections:
- Higher rate of genital mycotic infections, especially in women 1
- Small increase in urinary tract infections 1
- Caution recommended in people with recurrent or severe UTIs 1
Comparative Risk Among Antidiabetic Medications
When comparing medication classes for UTI risk:
DPP-4 inhibitors (including alogliptin): No significant increased risk of UTIs documented in major guidelines 1
SGLT2 inhibitors: Clearly associated with increased risk of UTIs
- Their use is associated with a small increase in urinary tract infections 1
- Caution should be used in people with recurrent or severe UTIs 1
- Studies show a 3.70 higher risk of UTI compared to non-SGLT2 inhibitors (95% CI 2.60-5.29) 2
- Incidence rates of UTI as high as 33.49% have been reported with SGLT2 inhibitors versus 11.72% in non-SGLT2 inhibitor groups 2
Clinical Implications and Recommendations
When considering alogliptin for patients with diabetes:
- Alogliptin can be prescribed without specific concerns about increased UTI risk 1
- No dose adjustment is required for alogliptin based on UTI risk (though dose adjustments are needed for kidney function) 1
- For patients with recurrent UTIs or at high risk for UTIs, alogliptin would be a safer choice than SGLT2 inhibitors 1, 2
Special Populations and Considerations
For patients with risk factors for UTIs:
- Elderly patients: Alogliptin does not carry specific UTI warnings for older adults 1
- Patients with urinary tract abnormalities: Unlike SGLT2 inhibitors, which should be used with caution in patients with urinary tract obstruction 3, alogliptin does not have this limitation
- Patients with history of recurrent UTIs: Alogliptin would be preferred over SGLT2 inhibitors 1, 2
Conclusion
When selecting antidiabetic medications for patients concerned about UTI risk, alogliptin and other DPP-4 inhibitors represent a safer option compared to SGLT2 inhibitors. The evidence from current guidelines and research does not indicate an increased risk of UTIs with alogliptin use.