Short answer: The Nesina label dose is 25 mg by mouth once daily, with or without food, and tablets are not split. With moderate kidney impairment (CrCl 30 to under 60 mL/min) the dose is 12.5 mg once daily, and with severe impairment or end-stage kidney disease it is 6.25 mg once daily. The label says not to double the next dose after a missed one.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Nesina is approved for: Nesina is alogliptin, a DPP-4 inhibitor. It is approved, along with diet and exercise, to improve blood sugar control in adults with type 2 diabetes (section 1). It is not recommended for type 1 diabetes.
Source
NESINA (alogliptin) tablets, for oral use, prescribing information and Medication Guide. Takeda Pharmaceuticals America. DailyMed, version published March 24, 2025. DailyMed setid a3768c7e-aa4c-44d3-bc53-43bb7346c0b0
Nesina is a tablet taken by mouth once daily, with or without food. Tablets are not split (section 2.1).
It comes as 25 mg, 12.5 mg and 6.25 mg tablets (section 3).
Kidney function is assessed before starting and periodically after (section 2.2).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Kidney function | Nesina dose |
|---|---|
| Normal or mild renal impairment (CrCl ≥60 mL/min) | 25 mg orally once daily (no dose adjustment) |
| Moderate renal impairment (CrCl ≥30 to <60 mL/min) | 12.5 mg once daily |
| Severe renal impairment (CrCl ≥15 to <30 mL/min) | 6.25 mg once daily |
| End-stage renal disease (CrCl <15 mL/min or requiring hemodialysis) | 6.25 mg once daily, without regard to the timing of dialysis |
Nesina has not been studied in people on peritoneal dialysis.
With insulin or a sulfonylurea, a lower dose of those medicines may be needed to reduce the risk of low blood sugar.
If liver tests are clearly abnormal and stay abnormal or worsen, Nesina is interrupted and not restarted without another explanation.
Tablets are stored at 25 C (77 F), with excursions from 15 to 30 C allowed.
If a dose is missed, the next dose is not doubled. The Medication Guide adds: if you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose, and take the next dose at your regular time. Do not take 2 doses of Nesina at the same time.
More on this: missed a dose of Nesina.
In Dose Track you set up Nesina as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.