Empagliflozin and Linagliptin (Oral)

Linagliptin and empagliflozin combination is a drug that is used in the treatment of high blood sugar levels that are symptomatic of type 2 diabetes.

Overview

In the US, linagliptin and empagliflozin combination is sold under the brand name, Glyxambi.

This drug is usually used in conjunction with a healthy diet and a regular exercise programme in order to control the amount of sugar in the blood that is too high as a result of type 2 diabetes.

The empagliflozin component of the drug stops the kidneys from absorbing glucose, while linagliptin controls the amount of sugar in the blood by stimulating the pancreas to create more insulin. The drug also instructs the patient's liver to stop making glucose when the patient's blood sugar levels rise too high.

Linagliptin and empagliflozin combination is not suitable for treating people who have type 1 insulin-dependent diabetes.

The medication is only available via a prescription from your GP and comes in tablet form.

Conditions treated

Type of medicine

  • Oral tablet

Side effects

In addition to its desired effects, some drugs can cause unwelcome side effects. You may not experience any of the effects mentioned in this guide, but if you do, you may need further medical treatment.

If you notice any of the effects listed below after you begin using linagliptin and empagliflozin combination, you should alert your GP immediately:

  • Vomiting
  • Feeling unusually tired or weak
  • Unexplained weight loss
  • Breathing troubles
  • Sweating
  • Stomach pains
  • Slurred speech
  • Shakiness
  • Severe joint pains
  • Seizures
  • Pain in the abdomen, stomach, or side, sometimes radiating to the back
  • Nightmares
  • Nausea
  • Lower side or back pain
  • Loss of consciousness
  • Loss of appetite
  • Hives or swellings on the eyelids, face, tongue, lips, throat, legs, hands, feet, or genitalia
  • Jaundice
  • Indigestion
  • Increased thirst
  • Increased hunger
  • Headache
  • Fruit-like breath odor
  • Frequent urge to urinate
  • Dry, flushed skin
  • Fever
  • Rapid heartbeat
  • Dry mouth
  • Dizziness
  • Burning or painful urination
  • Depression
  • Darkened urine
  • Cool, pale skin
  • Constipation
  • Confusion
  • Cold sweats
  • Chills
  • Blurred vision
  • Bloody or cloudy urine
  • Bloating
  • Bladder pain
  • Anxiety

Many of the side effects that are noted by some patients go away without the need for further medical attention, as the body becomes used to the new drug. Your doctor may also give you some ideas on how to manage any side effects that you may experience. However, if these effects do not go away after a couple of weeks or if they are particularly troublesome, you should contact your GP:

  • Vaginal itching, discharge, or odor
  • Sore throat
  • Sneezing
  • Runny or stuffy nose
  • Itching, redness, pain, or swelling around the area of the penis
  • Loss of voice
  • Headache
  • Ear congestion
  • Penal discharge with a strong odor
  • Difficulty with breathing
  • Body aches or pain

It should be noted that the effects listed in this guide may not be all-inclusive and some people may notice other effects. If you have any other odd feelings or experiences while taking linagliptin and empagliflozin combination, you should mention them to your medical practitioner.

Dosage

You should only take linagliptin and empagliflozin combination as instructed by your doctor. Do not take extra medication, do not take the tablets more frequently or for a longer time than you have been instructed to. Do not change your dose of linagliptin and empagliflozin combination, unless your doctor tells you to do so.

When you pick up your prescription, you will also be given a medication guide. Read the guide thoroughly and if you have any queries, speak to your doctor.

In addition to taking your medicine, you must follow the diet plan that you have been given by your GP. This is very important in controlling your condition and will ensure that the medication works correctly. In addition, you should take regular exercise and test your urine or blood sugar levels as directed by your doctor.

Linagliptin and empagliflozin combination may be taken with or without food.

The dose of linagliptin and empagliflozin combination given to every patient may vary. You should take your medication in accordance with your GPs directions or follow the instructions on the product label. The dosage levels outlined below are based on the average for this drug. Do not change your dose unless you are told to do so by your GP, even if they are different from those in this guide.

The amount of linagliptin and empagliflozin combination you are prescribed will depend on the strength of the pills. The number of daily doses, the time to leave between them, and the total duration of your course will depend on the condition for which you are being treated and on your body's reaction to the medicine.

Each tablet is comprised of 5 mg linagliptin and 10 mg empagliflozin.

For type 2 diabetes

  • Adults: Take one tablet daily, every morning. Your GP may adjust your dose as required, but you should not normally take more than 5 mg linagliptin and 25 mg empagliflozin.
  • Children: Your doctor will work out the correct dose and usage rate for your child.

If you forget to take a dose of your medicine, you should try to take it as soon as you can. In the event that it is almost time for your next due dose, omit the missed dose and revert to your usual schedule. Do not take double the dose.

Interactions

Some medicines should never be used at the same time, as this could cause an interaction to occur. However, in some cases it may be appropriate for you to use two drugs at once, even though they may interact. If this is the case, your GP will advise you on precautions that you can take in order to manage the interactions. While you are taking linagliptin and empagliflozin combination, you should not take any other prescription or over the counter medicine without first checking with your doctor.

It is not generally recommended to use this medicine with any of the drugs listed below, although this may be necessary in some cases. If both medications are to be used at the same time, your doctor may change the dose or how often you use one or both.

  • Tosufloxacin
  • Tipranavir
  • Timolol
  • Thioctic Acid
  • St John's Wort
  • Sparfloxacin
  • Sotalol
  • Rufloxacin
  • Rifapentine
  • Rifampin
  • Rifabutin
  • Prulifloxacin
  • Propranolol
  • Primidone
  • Practolol
  • Pindolol
  • Phenytoin
  • Penbutolol
  • Pefloxacin
  • Pazufloxacin
  • Pasireotide
  • Oxprenolol
  • Oxcarbazepine
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Nebivolol
  • Nadolol
  • Nadifloxacin
  • Moxifloxacin
  • Mitotane
  • Metoprolol
  • Metipranolol
  • Lomefloxacin
  • Levofloxacin
  • Levobunolol
  • Lanreotide
  • Labetalol
  • Gemifloxacin
  • Gatifloxacin
  • Fosphenytoin
  • Flumequine
  • Fleroxacin
  • Esmolol
  • Enzalutamide
  • Enoxacin
  • Efavirenz
  • Ciprofloxacin
  • Celiprolol
  • Carvedilol
  • Carteolol
  • Carbamazepine
  • Bisoprolol
  • Betaxolol
  • Besifloxacin
  • Balofloxacin
  • Atenolol
  • Acebutolol

Sometimes, it may not be best practice to use some medications with certain foods, with alcohol, or while using tobacco. You should discuss the ramifications of doing so with your GP before you begin taking linagliptin and empagliflozin combination.

Warnings

Before you begin using a particular drug, you should discuss the pros and cons of doing so with your GP.

If you have ever experienced an adverse reaction to linagliptin and empagliflozin combination or any other prescription or over the counter drug, you must tell your GP before you begin your course of treatment. Similarly, if you know that you are allergic to certain food groups, dyes, preservatives, or animal derivatives, you must tell your doctor.

Geriatric patients

Although there are no geriatric-specific problems related to the use of linagliptin and empagliflozin combination, it can cause issues with those who have age-related kidney problems. Caution is therefore advised when prescribing this drug to elderly people.

Pregnancy and breastfeeding

There is no evidence to suggest that linagliptin and empagliflozin combination poses any threat to the unborn fetus. However, if you are pregnant or if you are intending to become pregnant while you are receiving treatment with this drug, you should discuss the matter with your GP.

Similarly, there is nothing to suggest that linagliptin and empagliflozin combination passes into breast milk or that it can harm a nursing infant. However, you should discuss the safety of breastfeeding your infant while taking this drug with your doctor or midwife, and perhaps look into other methods of providing your child with appropriate nutrition until your treatment has finished.

Medical history

Some existing or historical medical conditions can affect how this medication works.

Using linagliptin and empagliflozin combination in patients who have a history of alcohol abuse or pancreatic insulin deficiency may cause serious side effects.

Linagliptin and empagliflozin combination should be used with caution in patients who suffer from any of the following conditions, as doing so could make these illnesses worse:

  • Vulvovaginitis
  • Urinary tract infections
  • Low blood pressure (hypotension)
  • Kidney disease
  • High fat or cholesterol in the blood (dyslipidemia)
  • Genital yeast or fungal infections
  • Dehydration
  • Balanoposthitis
  • Balanitis

Linagliptin and empagliflozin combination should never be used in patients with the following conditions:

  • Type 1 diabetes
  • Severe kidney disease
  • Patients who are receiving dialysis
  • High blood levels of ketones and acid (diabetic ketoacidosis)

The use of patients with any of the following conditions can increase the risk of pancreatitis (pancreatic swelling):

  • High cholesterol levels in the blood (hypercholesterolemia)
  • High blood levels of triglycerides and fats (hypertriglyceridemia)
  • Obesity
  • Pancreas disease or problems

You must attend your GP for regular progress checks throughout your course of treatment, particularly during the first few weeks. You will also be required to undergo urine and blood tests to check for any unwanted effects.

If you experience any of the effects listed below, you must consult your GP immediately as these can be signs of pancreatitis:

  • Vomiting
  • Severe and sudden stomach pain
  • Poor appetite
  • Nausea
  • Fever
  • Feeling lightheaded
  • Constipation
  • Chills

You may experience dehydration while using linagliptin and empagliflozin combination. This is more likely if you have kidney problems, low blood pressure, or if you are taking diuretics. If you begin to feel faint, dizzy or lightheaded, you may be dehydrated. To combat this, drink plenty of water each day, especially if the weather is very hot or if you have been exercising. If you have diarrhea or vomiting that persists, check with your GP for more advice.

Linagliptin and empagliflozin combination can cause a very serious medical condition called ketoacidosis. Ketoacidosis causes the levels of acid and ketones to become too high in your blood. The condition always requires immediate medical attention, and patients are treated with fluids, insulin, and carbohydrate replacement therapy to combat it. Signs of ketoacidosis to look out for include vomiting, nausea, breathing problems, increased urination and thirst.

Patients taking linagliptin and empagliflozin combination may develop low blood sugar, hypoglycemia. This condition is more usually seen in patients who are taking other medicines, including glipizide, glyburide, or insulin. It is important that you learn what symptoms could indicate hypoglycemia so that you can seek medical treatment before you pass out. Symptoms can vary between sufferers, but any or all of the following could indicate that you have low blood sugar:

  • Appearing to be drunk
  • Blurred vision
  • Cold sweats
  • Confusion
  • Pale skin
  • Problems thinking clearly
  • Drowsiness
  • Excessive hunger
  • Rapid heartbeat
  • Persistent headaches
  • Nausea
  • Shakiness
  • Slurred speech
  • Feeling unusually weak or tired

Patients who are taking linagliptin and empagliflozin combination are often prone to contracting vaginal or penile yeast infections. These problems more commonly affect women with a history of yeast infections and men who are not circumcised. Female symptoms may include itching, odor, or vaginal discharge. Men may experience strong odor or discharge from the penis. If you have any of these symptoms, check with your doctor straight away.

People taking linagliptin and empagliflozin combination have an increased risk of contracting urinary tract infections, including pyelonephritis and urosepsis. You must consult your GP immediately if you develop pain in your bladder, cloudy or bloody urine, painful, burning, or difficulty urinating, or pain in your side or lower back

Linagliptin and empagliflozin combination can cause a serious allergic response called anaphylaxis in some people. This condition is potentially life-threatening and always demands immediate emergency medical attention. Call 911 straight away if you notice any of the following signs, immediately after taking your tablet:

  • Rash
  • Itching
  • Breathing difficulties
  • Problems swallowing
  • Swelling of the hands, mouth, throat, or face

If you experience any severe pain in your joints, while you are using this medication, check with your doctor right away.

You must be sure to tell your treating physician or dentist that you are taking linagliptin and empagliflozin combination. This drug can compromise the effects of some medical tests, for example urine-glucose readings may not be accurate.

You should not take any other form of prescription or over the counter drugs while you are taking linagliptin and empagliflozin combination. This includes vitamin supplements or herbal preparations.

Storage

You should store your supply of linagliptin and empagliflozin combination in its original closed container at room temperature. Do not place the tablets where they might get damp. Keep the tablets out of direct sunlight and away from heat sources. Do not freeze the tablets or keep them in the refrigerator.

Put the tablets well away from children and pets. If a pet does eat your tablets, contact your vet immediately.

Do not take any tablets that have become out-of-date or that appear damaged. Do not keep unused tablets.

Dispose of unused tablets safely, and do not flush them down the toilet or drain. Place unwanted medicines in a sealed bag and put it at the bottom of your trash can. Alternatively, ask your pharmacist or GP to dispose of the medication for you.

Summary

Linagliptin and empagliflozin combination is a drug that is generally used to treat type 2 diabetes. The medicine should be used in conjunction with a balanced diet and regular exercise to control blood sugar levels that are too high. The drug is not suitable for use in patients with type 1 diabetes.

There are many drugs that should not be used at the same time as this medication because of the interactions that may occur. In addition, there are a number of serious medical conditions that can be made worse by linagliptin and empagliflozin combination. For these reasons, you must always discuss your medical history in full with your treating physician before you begin taking this drug. You must also remember to mention any unexpected or unusual effects that you notice while you are taking linagliptin and empagliflozin combination.

It is also very important that you keep all appointments that you may have with your GP throughout the course of your treatment. These appointments are designed to allow your doctor to keep a check on your progress and to make sure that the drug is working properly. You may also be asked to undergo urine and blood tests while you are taking this drug.