<prompt> DPP-IV inhibitor used in renal failure:LinagliptinSitagliptinVildagliptinSaxagliptin  <response>: A i.e. LinagliptinRef: HohIA, Ronsoni MF, Guedes EP, de Melo TG, Lauand F 2014, Linagliptin: DPP-4 Inhibition in the Treatment of Type 2, Diabetes Mellitus, J Diabetes Metab Disord Control 11: 00005, DOI: 10.15406jdmdc,2014.01.00005Explanation:Patients with T2DM have dysfunction in incretin hormones such as glucagon-like peptide-1 or GLP-1 and glucose-dependent insulinotropic polypeptide or GIP.By inhibiting the dipeptidyl peptidase-4 DPP-4 enzyme, it is possible to slow the inactivation of GLP-1 and GIP, promoting blood glucose level decrease in a glucose-dependent manner.Linagliptin is a dipeptidyl peptidase-4 inhibitor DPP IV inhibitor.Linagliptin is approved by FDA and EMA for the T2DM treatment as an anti-hyperglycemic agent that can be used as monotherapy or in combination with other medications metformin, sulphonylurea, pioglitazone, metformin plus sulphonylurea or insulin.NOTE:Linagliptin is safe in renal failure, as it is eliminated majorly by biliary excretion and it also undergoes enterohepatic recycling.Chemical and metabolic characteristics of DPP-4 inhibitorsInhibitorChemical StructureMetabolitesRoute of EliminationLinagliptinBased on XanthineNegligibleBiliary 70 unchanged; 6 via kidneySaxagliptinCyanopyrrolidineMetabolized in the liver to active metabolite via P450 3A45Renal 12-29 unchanged and 21-52 as metaboliteSitagliptinBased on p-amino acidNegligibleRenal 80 unchangedVildagliptinCyanopyrrolidineHydrolyzed to inactive metabolite P450 enzyme-independentRenal 22 unchanged and 55 as primary metaboliteAlogliptinPyrimidineDemethylated, acetylatedRenal 