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This requirement is less common in 2026 than it was in 2022 the clinical case for older agents as a step therapy precondition has weakened but it persists on some formularies, particularly for self-funded employer plans

Common side effects include: Nasopharyngitis and upper respiratory tract infections the most frequently reported adverse effects (mechanism not fully established) Headache and dizziness reported in some patients, particularly during the initial weeks of treatment Gastrointestinal symptoms such as nausea or constipation, though these are generally mild Less common but important safety considerations include: Hypoglycaemia : Although the risk is low when a gliptin is used alone or with metformin, it increases when combined with a sulfonylurea or insulin

There is a misconception that sperm count cant be increased, motility cant be increased patients wont get better

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