Indications

When treatment with both Linagliptin and Metformin Hydrochloride is appropriate, this is advised as an addition to diet and exercise to enhance glycemic control in persons with type 2 diabetes mellitus.

Pharmacology

Linagliptin is demonstrated to progress glycemic control in patients with sort 2 diabetes mellitus. Linagliptin is an inhibitor of DPP-4 (dipeptidyl peptidase-4), a protein that corrupts the incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose subordinate insulinotropic polypeptide). In this way, Linagliptin increments the concentrations of dynamic incretin hormones, invigorating the discharge of affront from pancreatic beta (β) cells in a glucose-dependent way and diminishing the emission of glucagon from pancreatic alpha (α) cells within the circulation. Metformin Hydrochloride may be a biguanide sort verbal antihyperglycemic sedate utilized within the administration of sort 2 diabetes. It brings down both basal and postprandial plasma glucose. Its component of activity is diverse from those of sulfonylureas and it does not deliver hypoglycemia.

Dosage & Administration

Linagliptin & Metformin immediate-release tablet: The dosage of Linagliptin & Metformin should be individualized on the basis of both effectiveness and tolerability. Maximum recommended dose of 2.5 mg Linagliptin and 1000 mg Metformin Hydrochloride twice daily with meals. Dose escalation should be gradual to reduce the gastrointestinal (GI) side effects associated with Metformin Hydrochloride use.

Recommended starting dose: In patients currently not treated with Metformin Hydrochloride, initiate treatment with 2.5 mg Linagliptin and 500 mg Metformin Hydrochloride twice daily. In patients already treated with Metformin Hydrochloride, start with 2.5 mg Linagliptin and the current dose of Metformin Hydrochloride twice daily. For patients already treated with Linagliptin and Metformin Hydrochloride, individual components may be switched to this combination containing the same doses of each component.

Linagliptin & Metformin extend release tablet: The dosage of this combination should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended total daily dose of Linagliptin 5 mg and Metformin Hydrochloride 2000 mg. this combination should be given once daily with a meal.

Recommended starting dose: In patients currently not treated with metformin, initiate this combination treatment with 5 mg Linagliptin/1000 mg Metformin Hydrochloride extended-release once daily with a meal. In patients already treated with Metformin, start this combination with 5 mg of Linagliptin total daily dose and a similar total daily dose of Metformin once daily with a meal. In patients already treated with Linagliptin & Metformin immediate-release tablet, switch to extend release tablet containing 5 mg of Linagliptin total daily dose and a similar total daily dose of Metformin once daily with a meal. 5 mg Linagliptin & 1000 mg Metformin Hydrochloride extended-release tablet should be taken as a single tablet once daily. Patients using 2.5 mg Linagliptin & 1000 mg Metformin extended-release tablets should take two tablets together once daily.

Interaction

Cationic drugs (amiloride, digoxin, morphine, ranitidine, trimethoprim, etc.): May reduce metformin elimination.

P-glycoprotein/CYP3A4 inducer (i.e., rifampin): The efficacy of this medicine may be reduced when administered in combination.

Contraindications

In spite of the fact that Linagliptin experiences negligible renal excretion, Metformin Hydrochloride is known to be significantly excreted by the kidney. The hazard of Metformin Hydrochloride amassing and lactic acidosis increments with the degree of renal disability. Hence, this combination is contraindicated in patients with renal impedance. It is additionally contraindicated in intense or incessant metabolic acidosis (diabetic ketoacidosis) and in extreme touchiness to Linagliptin or Metformin Hydrochloride.

Side Effect

Nasopharyngitis and diarrhea are the most common adverse effects. Patients taking this combination plus sulfonylureas are more likely to have hypoglycemia.

Pregnancy & Lactation

There are no satisfactory and well-controlled ponders in pregnant ladies with this combination or its person component; so, it ought to be utilized amid pregnancy as it were in the event that clearly required. Caution ought to moreover be exercised when it is managed to a lactating mother.

Precautions & Warnings

In an understanding with lactic acidosis who is taking Metformin, the medicate ought to be suspended quickly and steady treatment expeditiously organizations. There have been post-marketing reports of intense pancreatitis. On the off chance that pancreatitis is suspected, instantly cease Linagliptin & Metformin. Briefly cease Linagliptin & Metformin in patients experiencing radiologic considers with the intravascular organization of iodinated differentiate materials or any surgical methods requiring limited admissions of nourishment and liquids. Metformin may lower Vitamin B12 levels; so hematologic parameters should be observed every year.

Therapeutic Class

Combination Oral hypoglycemic preparations.

Storage Conditions

Even if the canister appears to be empty, it should not be punctured, broken, or incinerated. Avoid storing in direct sunlight or in a hot environment. Keep it below 30°C. Keep your distance from the eyes. Keep your distance from youngsters.