linagliptin and metformin (Oral route)
lin-a-GLIP-tin, met-FOR-min hye-droe-KLOR-ide
Lactic acidosis can occur due to metformin accumulation during treatment with linagliptin/metformin hydrochloride, and case reports of death, hypothermia, hypotension, and resistant bradyarrhythmias have been reported. The risk of lactic acidosis is increased with renal impairment, concomitant cationic drugs (eg, topiramate), age 65 years or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (eg, acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Onset is often subtle with symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities include elevated blood lactate levels (greater than 5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio, and metformin plasma levels generally greater than 5 mcg/mL. If lactic acidosis is suspected, immediately discontinue therapy, hospitalize patient, and promptly start hemodialysis .
Commonly used brand name(s)
In the U.S.
- Jentadueto XR
Available Dosage Forms:
- Tablet, Extended Release
Therapeutic Class: Antidiabetic
Pharmacologic Class: Dipeptidyl Peptidase IV Inhibitor
Chemical Class: Metformin
Uses For linagliptin and metformin
Linagliptin and metformin combination is used to treat high blood sugar levels caused by type 2 diabetes. Linagliptin helps to control blood sugar levels by increasing substances in the body that make the pancreas release more insulin. It also signals the liver to stop producing sugar (glucose) when there is too much sugar in the blood. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. linagliptin and metformin does not help patients who have insulin-dependent or type 1 diabetes.
linagliptin and metformin is available only with your doctor's prescription.
Before Using linagliptin and metformin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For linagliptin and metformin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to linagliptin and metformin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of linagliptin and metformin combination in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of linagliptin and metformin combination in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving linagliptin and metformin.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking linagliptin and metformin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using linagliptin and metformin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Acetrizoic Acid
- Ethiodized Oil
- Iobenzamic Acid
- Iocarmic Acid
- Iocetamic Acid
- Iodohippuric Acid
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iopanoic Acid
- Iopronic Acid
- Ioseric Acid
- Iotroxic Acid
- Ioxitalamic Acid
- Metrizoic Acid
- Tyropanoate Sodium
Using linagliptin and metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- St John's Wort
- Thioctic Acid
Using linagliptin and metformin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bitter Melon
- Guar Gum
- Methylene Blue
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of linagliptin and metformin. Make sure you tell your doctor if you have any other medical problems, especially:
- Adrenal glands (underactive) or
- Alcohol, excessive use or
- Congestive heart failure, acute or unstable or
- Dehydration or
- Heart attack, acute or
- Hypoxemia (decreased oxygen in the blood) or
- Liver disease or
- Pituitary gland (underactive) or
- Poorly nourished condition or
- Sepsis (severe infection) or
- Shock (low blood pressure, blood circulation is poor) or
- Weakened physical condition—Use with caution. May cause side effects to become worse.
- Anemia (low blood cells) or
- Vitamin B12 deficiency—Use with caution. May make these conditions worse.
- Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history with this medication or other dipeptidyl peptidase-4 (DPP-4) inhibitors—Use with caution. May increase the risk of this condition occurring again.
- Diabetic ketoacidosis or metabolic acidosis (high ketones and acid in the blood) or
- Kidney disease, severe or
- Type I diabetes—Should not be used in patients with these conditions.
- Fever or
- Infection of any type or
- Surgery (major) or
- Trauma—These conditions may cause temporary problems with blood sugar control and your doctor may want to treat you with insulin.
- Heart failure, history of or
- Kidney damage, history of—May increase risk for heart failure.
- Hypercholesterolemia (high cholesterol in the blood) or
- Hypertriglyceridemia (high triglycerides and fats in the blood) or
- Obesity or
- Pancreas problems, history of—Use with caution. May increase risk for pancreatitis (swelling of the pancreas).
Proper Use of linagliptin and metformin
Take linagliptin and metformin exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.
linagliptin and metformin usually comes with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
Carefully follow the special meal plan your doctor gave you. This is the most important part of controlling your diabetes, and is necessary if the medicine is to work properly. Exercise regularly and test for sugar in your blood or urine as directed.
Take linagliptin and metformin with meals.
Swallow the extended-release tablet whole. Do not crush, break, or chew it.
A part of the extended-release tablet may pass into your stools. This is normal and is nothing to worry about.
The dose of linagliptin and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of linagliptin and metformin. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (extended-release tablets):
- For type 2 diabetes:
- Patients taking metformin alone—The metformin dose is the same as the dose you are already taking plus 5 milligrams (mg) of linagliptin. Your doctor may adjust your dose until your blood sugar is controlled. However, the dose is usually not more than 5 mg of linagliptin and 2000 mg of metformin once a day.
- Patients taking linagliptin alone—At first, one tablet containing 5 mg of linagliptin and 1000 mg of metformin once a day. Your doctor may gradually increase your dose until your blood sugar is controlled. However, the dose is usually not more than 5 mg of linagliptin and 2000 mg of metformin once a day.
- Patients taking linagliptin and metformin as separate components or Jentadueto® tablets—The metformin dose is the same as the dose you are already taking plus 5 mg of linagliptin. Your doctor may adjust your dose until your blood sugar is controlled. However, the dose is usually not more than 5 mg of linagliptin and 2000 mg of metformin once a day.
- Children—Use and dose must be determined by your doctor.
- For type 2 diabetes:
- For oral dosage form (tablets):
- For type 2 diabetes:
- Patients taking metformin alone—The metformin dose is the same as the dose you are already taking. Your doctor may adjust your dose until your blood sugar is controlled. However, the dose is usually not more than 2.5 milligrams (mg) of linagliptin and 1000 mg of metformin 2 times a day.
- Patients taking linagliptin alone—At first, 1 tablet containing 2.5 mg of linagliptin and 500 mg of metformin 2 times a day. Your doctor may gradually increase your dose until your blood sugar is controlled. However, the dose is usually not more than 2.5 mg of linagliptin and 1000 mg of metformin 2 times a day.
- Patients taking linagliptin and metformin as separate components—The linagliptin and metformin dose are the same as the dose you are already taking. Your doctor may adjust your dose until your blood sugar is controlled. However, the dose is usually not more than 2.5 mg of linagliptin and 1000 mg of metformin 2 times a day.
- Children—Use and dose must be determined by your doctor.
- For type 2 diabetes:
If you miss a dose of linagliptin and metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep the tablets dry.
Precautions While Using linagliptin and metformin
It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take linagliptin and metformin. Blood and urine tests may be needed to check for unwanted effects.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and appear quickly. It usually occurs when other serious health problems are present, such as a heart attack or kidney failure. Symptoms of lactic acidosis include: abdominal or stomach discomfort, decreased appetite, diarrhea, fast or shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness. If you have more than one of these symptoms together, you should get emergency medical help right away.
Do not let yourself get dehydrated. Be sure to drink extra fluids when you exercise or increase your activity, or if you have vomiting or diarrhea.
Pancreatitis may occur while you are using linagliptin and metformin. Check with your doctor right away if you have a sudden and severe stomach pain, chills, constipation, nausea, vomiting, loss of appetite, fever, or lightheadedness.
Check with your doctor right away if you have more than one of these symptoms: chest pain, decreased urine output, dilated neck veins, extreme fatigue, irregular breathing, irregular heartbeat, shortness of breath, swelling of the face, fingers, feet, or lower legs, tightness in the chest, trouble breathing, or weight gain. These may be signs of heart failure.
Let your doctor or dentist know you are taking linagliptin and metformin. Your doctor may advise you to temporarily stop taking linagliptin and metformin before you have major surgery or diagnostic tests, including procedures that use contrast dye.
It is very important to carefully follow any instructions from your health care team about:
- Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
- Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
- Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about the changes in the dosing of their diabetes medicine that might occur with lifestyle changes, such as changes in exercise or diet. Furthermore, counseling on contraception and pregnancy may be needed, because of the problems that can occur in patients with diabetes during pregnancy.
- Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
- In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes and that lists all of your medicines.
linagliptin and metformin may cause hypoglycemia (low blood sugar). This is more common when linagliptin and metformin is taken together with certain medicines. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly. Talk to your doctor about the best way to treat low blood sugar.
Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar.
linagliptin and metformin may cause severe and disabling joint pain. Call your doctor right away if you have severe joint pain while using linagliptin and metformin.
linagliptin and metformin may cause bullous pemphigoid. Tell your doctor right away if you have large, hard skin blisters while you are using linagliptin and metformin.
Do not drink a lot of alcohol while you are using linagliptin and metformin. Heavy alcohol use can increase your risk for lactic acidosis.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
linagliptin and metformin Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:Less common
- blurred vision
- cold sweats
- cool, pale skin
- fast heartbeat
- increased hunger
- loss of consciousness
- slurred speech
- unusual tiredness or weakness
- darkened urine
- fainting spells
- irregular heartbeat
- large, hard skin blisters
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- pains in the stomach, side, or abdomen, possibly radiating to the back
- severe joint pain
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- excess air or gas in the stomach or intestines
- feeling of fullness
- lack or loss of strength
- muscle aches
- passing gas
- sore throat
- stuffy or runny nose
- decreased appetite
- difficulty with moving
- flaking and falling off of the skin
- hives or welts, itching, or skin rash
- muscle aching or cramping
- muscle pains or stiffness
- redness of the skin
- swollen joints
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
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