Linagliptin / Metformin Side Effects

Medically reviewed by Drugs.com. Last updated on Apr 7, 2025.

Applies to linagliptin / metformin: oral tablet, oral tablet extended release.

Precautions

It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine. Blood and urine tests may be needed to check for unwanted effects.

Under certain conditions, too much metformin can cause lactic acidosis. It usually occurs when other serious health problems are present, such as a heart attack or kidney failure. Symptoms of lactic acidosis include: 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 immediate emergency medical help.

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 this medicine. 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.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine before having a major surgery or diagnostic tests, especially tests that use a 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.

This medicine may cause hypoglycemia (low blood sugar). This is more common when this medicine 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. Some symptoms of low blood sugar include: behavior changes that are similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, a fast heartbeat, headaches that continue, nausea, shakiness, slurred speech, or unusual tiredness or weakness. Talk to your doctor about how 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.

This medicine may cause severe and disabling joint pain. Call your doctor right away if you have severe joint pain while using this medicine.

This medicine may cause bullous pemphigoid. Tell your doctor right away if you have large, hard skin blisters while you are using this medicine.

Check with your doctor right away if you have chest pain or tightness, decreased urine output, dilated neck veins, extreme fatigue, irregular breathing, irregular heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain. These may be signs of heart failure.

Limit the amount of alcohol you drink while you are using this medicine. Heavy alcohol use can increase your chances of serious side effects.

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.

Other side effects

Some side effects of linagliptin / metformin 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:

Serious side effects

Along with its needed effects, linagliptin / metformin 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 while taking linagliptin / metformin:

For healthcare professionals

Applies to linagliptin / metformin: oral tablet, oral tablet extended release.

General adverse events

The most commonly reported adverse events included nasopharyngitis and diarrhea.^[Ref]

Metabolic

Linagliptin-Metformin:

• Frequency not reported: Hypoglycemia

Linagliptin:

• Common (1% to 10%): Hypertriglyceridemia, hyperlipidemia, weight increased

Metformin:

• Very rare (less than 0.01%): Lactic acidosis, vitamin B12 deficiency^[Ref]

Hypoglycemia was more commonly reported in patients receiving the combination linagliptin / metformin plus a sulfonylurea compared with those receiving metformin plus a sulfonylurea (22.9% vs 14.8%; n=792).^[Ref]

Gastrointestinal

Linagliptin-Metformin:

• Common (1% to 10%): Decreased appetite, diarrhea, nausea, vomiting
• Uncommon (0.1% to 1%): Increased blood amylase
• Postmarketing reports: Mouth ulceration

Linagliptin:

• Common (1% to 10%): Constipation, diarrhea
• Frequency not reported: Pancreatitis
• Postmarketing reports: Acute pancreatitis, including fatal pancreatitis, stomatitis

Metformin:

• Very common (10% or more): Diarrhea, nausea, vomiting, abdominal pain, decreased appetite
• Common (1% to 10%): Constipation
• Frequency not reported: Flatulence, indigestion^[Ref]

Gastrointestinal events such as nausea, vomiting, diarrhea, decreased appetite, and abdominal pain occur most frequently during initiation of therapy and resolve spontaneously in most cases.

During clinical trials, pancreatitis was reported in 15.2 cases per 10,000 patient year exposure in patients receiving linagliptin compared with 3.7 cases per 10,000 patient year exposure in those receiving active comparator (sulfonylurea). Following completion of clinical trials, 3 additional cases of pancreatitis were reported among those receiving linagliptin. Postmarketing reports of acute pancreatitis, including fatalities, have been received.^[Ref]

Hypersensitivity

Linagliptin-Metformin:

• Rare (less than 0.1%): Drug hypersensitivity

Linagliptin

• Postmarketing reports: Serious hypersensitivity reactions^[Ref]

Serious hypersensitivity reactions including anaphylaxis, angioedema, and exfoliative skin conditions have been reported postmarketing in patients treated with linagliptin. These reactions have occurred within the first 3 months, with some occurring after the first dose.^[Ref]

Respiratory

• Common (1% to 10%): Nasopharyngitis (6.3%),
• Uncommon (0.1% to 1%): Cough
• Common (1% to 10%): Nasopharyngitis, cough
• Common (1% to 10%): Nasopharyngitis^[Ref]

Linagliptin-Metformin

Linagliptin

Metformin

Dermatologic

Linagliptin-Metformin:

• Uncommon (0.1% to 1%): Pruritus
• Postmarketing reports: Angioedema, urticaria, rash

Metformin:

• Very rare (less than 0.01%): Skin reactions such as erythema, pruritus, and urticaria

Linagliptin:

• Postmarketing reports: Bullous pemphigoid^[Ref]

Postmarketing reports of bullous pemphigoid requiring hospitalization have been reported with dipeptidyl peptidase-4 (DPP-4) inhibitors use. These case typically recovered with topical or systemic immunosuppressive treatment and discontinuation of DPP-4 inhibitor.^[Ref]

Hematologic

• Very rare (less than 0.01%): Megaloblastic anemia^[Ref]

Metformin

Hepatic

Metformin:

• Very rare (less than 0.01%): Hepatitis, liver function test abnormalities
• Postmarketing reports: Cholestatic, hepatocellular, and mixed hepatocellular liver injury^[Ref]

Musculoskeletal

Linagliptin:

• Frequency not reported: Myalgia, arthralgia
• Postmarketing reports: Severe and disabling arthralgia, rhabdomyolysis^[Ref]

Between October 2006 and December 2013, thirty-three cases of severe arthralgia have been reported to the FDA Adverse Event Reporting System Database. Each case involved the use of 1 or more dipeptidyl peptidase-4 (DPP-4) inhibitor. In all cases, substantial reduction in prior activity level was reported, 10 patients were hospitalized due to disabling joint pain. In 22 cases, symptoms appeared within 1 month of starting therapy, in 23 cases symptoms resolved less than 1 month after discontinuation. A positive rechallenge was reported in 8 cases, with 6 cases involving use of a different DPP-4 inhibitor. Sitagliptin had the greatest number of cases reported (n=28) followed by saxagliptin (n=5), linagliptin (n=2), alogliptin (n=1), and vildagliptin (n=2).^[Ref]

Nervous system

Metformin:

• Common (1% to 10%): Taste disturbance^[Ref]

Genitourinary

Linagliptin:

• Common (1% to 10%): Urinary tract infection,^[Ref]

Psychiatric

Linagliptin:

• Common (1% to 10%): Headache

Metformin:

• Common (1% to 10%): Headache^[Ref]

See also:

Further information

Linagliptin/metformin side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer