Linagliptin and metformin (Oral)

Overview

Linagliptin and metformin is prescribed for treatment of high levels of blood sugar typically due to type 2 diabetes. Blood sugar levels are regulated by linagliptin because substances within the body are increased which cause the pancreas to discharge additional insulin. Linagliptin also informs the liver as to when it should stop manufacturing glucose (sugar) when the blood has an excessive amount of blood sugar. Metformin lowers the rate of sugar absorption from the stomach, aids the body in better utilization of sugar, and lowers how much stored sugar is discharged from the liver. When combined with exercise and a proper diet, high hyperglycemia levels can be regulated with this medication.

This medication can only be obtained with a valid prescription from your physician. It is currently only available in tablet dosage form, as well as extended release tablet form. This is manufactured under the US brand name of Jentadueto.

Condition treated

  • Hyperglycemia caused by type 2 diabetes

Type of medicine

  • Oral, tablets

Side Effects

In addition to the beneficial aspects of medications, drugs can also cause side effects that may be undesirable at times. While it is not typical for each one of the following side effects to take place, if they do occur, emergency medical care may be required.

Consult with your physician right away if you experience any of the side effects listed below:

Less common side effects:

  • Weakness or tiredness (unusual)
  • Speech slurred
  • Shakiness
  • Seizures
  • Pale, cool skin
  • Nightmares
  • Nausea
  • Hunger increase
  • Heartbeat quickness
  • Headache
  • Dizziness
  • Depression
  • Confusion
  • Coma
  • Cold sweats
  • Chills
  • Blurred vision
  • Anxiety

Additional side effects (occurrence rate unknown):

  • Yellow skin or eyes
  • Vomiting
  • Urine that is dark in appearance
  • Pains in the back, abdomen, side, or stomach
  • Lightheadedness or fainting spells
  • Joint pain (severe)
  • Indigestion
  • Hive-like swelling (large) on the feet, legs, sex organs, hands, throat, tongue, lips, eyelids, or face
  • Heartbeat irregularity
  • Fever
  • Constipation
  • Bloating
  • Appetite loss

Certain side effects could take place that typically do not require medical care. These particular side effects have a high likelihood of diminishing throughout the course of treatment as your body becomes more adjusted to the medication. In addition, your medical care professional can likely inform you of additional methods of reducing or preventing certain side effects. Consult with your physician if the side effects below become troublesome, prolonged, or if you have concerns or questions regarding them:

More common side effects:

  • Throat soreness
  • Runny or stuffy nose
  • Loss of or lack of strength
  • Heartburn
  • Gas passing
  • Feeling of fullness
  • Excess gas or air in the intestines or stomach
  • Diarrhea
  • Aches of muscles

Occurrence rate unknown:

  • Skin redness
  • Rash, itching, welts, or skin hives
  • Muscle stiffness or pain
  • Muscle cramping or aching
  • Moving difficulty
  • Joint swelling
  • Falling off and flaking of skin
  • Cough
  • Appetite decrease

Additional side effects not included above could also take place for certain patients. It other side effects take place, be sure to inform your doctor.

Contact your physician if you are seeking any kind of medical advice regarding side effects. The Food and Drug Administration also accepts reports of side effects, and they can be reached by calling 1-800-FDA-1088.

Dosage

Your physician can inform you of a safe quantity of medication you should take for your unique circumstances. Your dose will likely need to be altered several times to find out the best dose for you. Never take an amount of this medication that is more than prescribed, and do not take this medication more frequently than instructed by your physician.

This medication is typically distributed with a medication overview guide. Follow and read all directions cautiously. Consult with your physician with any questions you may have.

Carefully abide by the directed meal plan that your physician provided you with. This portion is the most essential part of diabetes control. It is also imperative for the medication to work correctly. Regularly exercise and measure the levels of blood sugar or urine as needed or instructed.

The linagliptin and metformin combination should be taken with meals.

Take this medication in its entirety in one piece. Never chew, break, or crush it.

Patients who are prescribed the extended-release tablet form of linagliptin and metformin may experience a small portion of the tablet passing to their stools. Don't worry; this is normal.

Different patients will be given a unique dose of the linagliptin and metformin combination. Always follow the label directions or your physician's instructions. The information included in this article summarizes only typical doses of linagliptin and metformin. If you were prescribed a dose that differs from the information listed here, do not adjust your dose unless your physician approves the change.

The strength of the medication will determine how much linagliptin and metformin you are prescribed. In addition, the total number of doses taken per day, the allotted time between each dose, and the total duration for which the medication is taken will determine how much medication is prescribed.

For patients taking the tablet dose of linagliptin and metformin (extended-release) with type 2 diabetes:

Adults:

O Patients who have been taking metformin by itself should take the same dose of metformin they are already taking, but add linagliptin (5 milligrams). Your physician may increase your prescribed dose until the levels of blood sugar have been more controlled within your body. The total dose does not typically exceed 2000 milligrams of metformin and 5 milligrams of linagliptin one time daily.

O Patients who have been taking linagliptin by itself should take 1000 milligrams of metformin and one tablet (5 mg) initially of linagliptin. The dose may be increased slowly until blood sugar levels reach a state of control. The total dose typically will not be greater than 2000 milligrams of metformin and 5 milligrams of linagliptin each day.

O Patients who have been taking metformin and linagliptin separately or the Jentadueto® medication: Take a dose of metformin that is similar to the existing dose you are taking plus 5 milligrams of linagliptin. Your physician may change the dose until you have reached a controlled dose that your body is responding to. The total dose taken per day should not exceed 2000 milligrams of metformin or 5 milligrams of linagliptin.

Children: Physician must determine dose.

For patients taking the tablet form with type 2 diabetes (not the extended-release tablet):

Adults:

O Patients who have been taking metformin by itself: Take a dose of metformin that is the same that you are already on. Your physician may choose to change your dose until the blood sugar reaches a level that is more controlled. In addition, the total dose is not typically greater than 1000 milligrams of metformin and 2.5 mg of linagliptin twice per day.

O Patients who take linagliptin by itself: Initially, one tablet that contains 500 milligrams of metformin and 2.5 milligrams of linagliptin should be taken twice daily. Your physician may choose to increase the dose until your levels of blood sugar are more regulated. However, typical dose is not usually greater than 1000 mg of metformin and 2.5 mg of linagliptin twice daily.

O Patients who were taking metformin and linagliptin separately: The dose that you are already taking should remain unchanged. Your physician may choose to change the prescribed dose until your levels of blood sugar are more in control. However, the typical dose is not greater than 1000 milligrams of metformin and 2.5 milligrams of linagliptin twice daily.

Children: A Pediatrician must calculate unique dosage information.

Patients who miss a dose of linagliptin and metformin should take the medication as soon as they remember. However, if it is nearer to the scheduled next dose, the skipped dose may remain missed and you may return to the original dosage schedule. Never take a double dose of linagliptin and metformin.

Interactions

While some medications should not be taken simultaneously, separate medications can be combined under certain circumstances despite the likelihood of an interaction taking place. Under these circumstances, your physician may be inclined to alter your dose, or they may choose to take other types of precautions to protect you as a patient.

While taking linagliptin and metformin, it is essential that your physician is aware if you are already taking any of the medications on the following list. The interactions included here were chosen due to the potential significance of the combination, but this list is not all-inclusive.

Taking this medication in combination with the drugs below is not suggested. Your physician may choose not to prescribe linagliptin and metformin, or they may alter the dose for other medications you may be taking.

  • Tyropanoate Sodium
  • Metrizoic Acid
  • Metrizamide
  • Ipodate
  • Ioxitalamic Acid
  • Ioxaglate
  • Ioversol
  • Iotroxic Acid
  • Iotrolan
  • Iothalamate
  • Iotasul
  • Iosimide
  • Ioseric Acid
  • Iopronic Acid
  • Iopromide
  • Iophendylate
  • Iopentol
  • Iopanoic Acid
  • Iopamidol
  • Iomeprol
  • Iohexol
  • Ioglycamic Acid
  • Ioglicic Acid
  • Iodoxamic Acid
  • Iodopyracet
  • Iodohippuric Acid
  • Iodixanol
  • Iodipamide
  • Iodamide
  • Iocetamic Acid
  • Iocarmic Acid
  • Iobitridol
  • Iobenzamic Acid
  • Ethiodized Oil
  • Diatrizoate
  • Acetrizoic Acid

Taking linagliptin and metformin with any of the medications below is not typically suggested, but certain circumstances may require the combination. If both medications are prescribed at the same time, your physician may alter the dose or frequency for either just one or both medications.

  • Vandetanib
  • Tosufloxacin
  • Tipranavir
  • Thioctic Acid
  • St John's Wort
  • Sparfloxacin
  • Rufloxacin
  • Ritonavir
  • Rifapentine
  • Rifampin
  • Rifabutin
  • Prulifloxacin
  • Primidone
  • Phenytoin
  • Pefloxacin
  • Pazufloxacin
  • Pasireotide
  • Paritaprevir
  • Oxcarbazepine
  • Ombitasvir
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Nadifloxacin
  • Moxifloxacin
  • Mitotane
  • Lomefloxacin
  • Levofloxacin
  • Lanreotide
  • Gemifloxacin
  • Gatifloxacin
  • Fosphenytoin
  • Flumequine
  • Fleroxacin
  • Enzalutamide
  • Enoxacin
  • Efavirenz
  • Dolutegravir
  • Dofetilide
  • Dasabuvir
  • Ciprofloxacin
  • Carbamazepine
  • Bupropion
  • Besifloxacin
  • Balofloxacin
  • Aspirin

Taking linagliptin and metformin with the medications below could trigger a heightened likelihood of some side effects taking place, however the combination of both medications could prove to be the most optimal form of treatment for your situation. If both medications are prescribed simultaneously, your physician may alter the dose or frequency for either one or both drugs.

  • Tranylcypromine
  • Timolol
  • Sotalol
  • Selegiline
  • Safinamide
  • Rifampin
  • Rasagiline
  • Ranolazine
  • Psyllium
  • Propranolol
  • Procarbazine
  • Practolol
  • Pindolol
  • Phenelzine
  • Penbutolol
  • Patiromer
  • Oxprenolol
  • Nialamide
  • Nebivolol
  • Nadolol
  • Moclobemide
  • Metoprolol
  • Metipranolol
  • Methylene Blue
  • Linezolid
  • Levobunolol
  • Labetalol
  • Isocarboxazid
  • Iproniazid
  • Guar Gum
  • Glucomannan
  • Furazolidone
  • Fenugreek
  • Esmolol
  • Celiprolol
  • Carvedilol
  • Carteolol
  • Bitter Melon
  • Bisoprolol
  • Betaxolol
  • Atenolol
  • Acebutolol

Some medications should not be taken near mealtime or around the time of drinking or eating as interactions have a higher likelihood of taking place. The use of tobacco or alcohol with some medications could also trigger interactions to take place. The interactions listed here were chosen due to the possible significance, but the list below is not entirely all-inclusive.

Other medical issues could also potentially impact how linagliptin and metformin affects the patient. Be sure to inform your physician of other medical issues you may have, specifically:

  • Vitamin B12 deficiency' take caution, conditions can be made worse
  • Type 1 diabetes' patients with such conditions should not take this medication
  • Trauma ' such conditions could trigger short-lived issues with controlling your blood sugar, your physician may wish to prescribe insulin for your treatment
  • Surgery (major)
  • Shock (poor blood circulation, low levels of blood sugar)
  • Sepsis (serious infection)
  • Poor physical condition (weakness) take caution, side effects may become more intensified
  • Poor nourishment
  • Pituitary gland (underactive)
  • Pancreas issues (history of) take caution; risk of pancreatitis could be increased
  • Obesity
  • Metabolic acidosis or diabetic ketoacidosis high acidity and ketones in the blood
  • Liver disease
  • Kidney issues (severe) or kidney disease
  • Infections of any kind
  • Hypoxemia (reduced oxygen levels within blood)
  • Hypertriglyceridemia (high levels of fats and triglycerides in blood)
  • Hypercholesterolemia (high levels of cholesterol in blood)
  • Heart attack (acute)
  • Fever
  • Dehydration
  • Congestive heart failure (unstable or acute)
  • Angioedema (swelling of the legs, arms, throat, tongue, lips, or face) patients who have a history of taking this medication or medications that are dipeptidyl peptidase-4 (DPP-4) inhibitors should take caution. The risk of such conditions taking place again could be increased.
  • Anemia (low count of blood cells)
  • Alcohol (specifically excessive use)
  • Adrenal glands (underactive)

Warnings

In certain circumstances, an excessive amount of metformin can trigger lactic acidosis. Signs of lactic acidosis are sudden to appear and severe, and typically only take place when other unrelated health issues take place and are highly serious, such as kidney failure or heart attack. Signs of lactic acidosis are unusual weakness, tiredness, or sleepiness; general sensation of cramping, muscle pain, or discomfort; shallow or fast breathing; diarrhea; reduced appetite; or stomach or abdominal discomfort. If signs of lactic acidosis take place, emergency medical treatment should be obtained immediately.

Do not allow yourself to become dehydrated. Ensure that you are drinking plenty of fluids while exercising or increase physical activity if you experience diarrhea or vomiting.

Pancreatitis could take place for patients who are taking this medication. Consult with your physician immediately if you experience severe and sudden stomach pain, loss of appetite, lightheadedness or fever, appetite loss, vomiting, nausea, constipation, or chills.

Be sure to inform your dentist or physician prior to taking linagliptin and metformin. Your physician may recommend for you to stop taking this medication temporarily prior to having any types of diagnostic testing or major surgeries, including procedures utilizing contrast dye.

It is highly essential that you follow all directions from your medical care professional regarding the following:

  • Emergency precautions: there could be instances where are you are in need of emergency assistance for an issue caused by diabetes. Patients must be prepared for emergencies such as these. Patients with diabetes should wear a neck chain or bracelet for medical identification at all times. In addition, an identification card stating that you have diabetes and that lists the medications you are taking should also be carried at all times.
  • Travel: take a prescription (recent) and a copy of your medical history along with you. Prepare for any emergency normally, like you would at home. Allow for changes in time zones, and try to keep meals scheduled near the normal times as much as possible.
  • Alcohol: alcohol can severely lower your blood sugar. If you have any concerns, seek help from your medical professional.
  • Other medication: other drugs should not be taken unless previously improved by your physician. Specifically, this refers to medications available over the counter such as sinus, cough, hay fever, cold, asthma, appetite control medications or aspirin.
  • Counseling: additional family members may need to become familiar with the prevention of side effects, or they may need to learn how to treat side effects if they take place. Patients who have diabetes could require initial counseling regarding diabetes dosage medication changes that could take place, such as how exercise or diet affect dosage. Also, patients may benefit from having counseling on pregnancy if they are planning on becoming pregnant, because patients with diabetes can experience more difficulties during their pregnancy.

Low blood sugar (hypoglycemia) can take place from taking this medication. However, this can take place also if you take this medication with another kind of diabetes drug, cannot eat due to vomiting or nausea, exercise a greater amount than you usually do, drink alcohol, or miss a snack or meal. Signs of low blood sugar have to be taken care of prior to the patient passing out or becoming unconscious. Different individuals tend to feel different signs of low blood sugar. It is highly important that you become familiar with the signs of low blood sugar that you typically experience in order to quickly treat it.

Some signs of low blood sugar are weakness or tiredness (unusual), slurred speech, shakiness, restless sleep, nightmares, nervousness, nausea, headache (prolonged), quick heart beat, excessive hunger, drowsiness, difficulty thinking, pale skin, confusion, cold sweats, blurred vision, behavioral tendencies like a drunken state, or anxiety.

If signs of low blood sugars take place, eat sugar water, soft drinks that are not diet, fruit juice, sugar cubes, honey, corn syrup, or glucose gel or tablets. Monitor your levels of blood sugar to ensure you are not experiencing low blood sugar. Glucagon can be utilized in emergency medical situations in which serious signs (convulsions or seizures) or unconsciousness may take place. Have a kit with glucagon nearby, in addition to a needle and syringe, and be aware of how to properly use these tools. Your family members should also be aware of proper use.

High blood sugar (hyperglycemia) could take place if patients don't exercise the amount that they are supposed to, if they have an infection or fever, if they skip a dose or do not take a dose that is the amount required of the diabetes medication, or if they go off of the meal plan and they overeat.

Signs of high blood sugar (hyperglycemia) can be: thirst (unusual), difficulty breathing (deep and rapid breaths), tiredness, vomiting, nausea, stomach ache, sleepiness, appetite loss, urine containing ketones, urination volume and frequency increase, breath odor that is fruit-like, dry skin, flushed skin, dry mouth, drowsiness, or blurred vision.

If signs of high blood sugar levels take place: first check the levels of your blood sugar and then contact your physician for further directions.

This medication can trigger disabling and severe joint pain. Contact your physician immediately if you experience serious joint pain while taking linagliptin and metformin.

When contemplating whether or not the medication is right for you, patients should carefully compare the possible risks of the medication against the potential benefits it may provide. Patients should make this decision closely along with their physician. Consider the following aspects prior to taking the linagliptin and metformin combination.

Your doctor must be informed if you have experienced allergic reactions or unusual reactions to linagliptin and metformin or any other type of medication. Also inform your doctor of other kinds of allergies you may have, including to animals, preservatives, dyes, or foods.

Children under the age of 18 should not take this medication as it has not yet been identified whether or not this drug is both safe and effective for young children.

Research has not identified any issues for elderly patients taking linagliptin and metformin that could inhibit the effectiveness of this medication. However, patients who are older have a higher likelihood of having age-related kidney issues, which could require additional caution or a dose adjustment.

Your physician will need to monitor your progress regularly, specifically when you first begin taking this medication. Urine and blood tests could be required to monitor for undesired side effects.

Storage

Always keep linagliptin and metformin in a container that is sealed completely. It should be kept far from freezing or hot temperatures and kept away from any direct light or moisture.

Keep this medication far from children's reach. Medication that is not required any longer or that is expired should be disposed of.

Summary

The linagliptin and metformin combination is prescribed for the treatment of high levels of blood sugar that occur because of type 2 diabetes. Blood sugar levels are controlled by linagliptin due to the substances within the body that are increased, and this causes the pancreas to discharge additional insulin. Linagliptin also notifies the liver as to when it should discontinue the manufacturing of glucose when the blood has an unnecessary amount of blood sugar. Metformin reduces the rate of sugar absorption from the stomach, helps the body with better utilization of sugar, and reduces the amount of stored sugar that is discharged from the liver. When combined with exercise and a proper diet, high hyperglycemia levels can be controlled with this prescription.