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linagliptin (Tradjenta)

Indications: - adjunct to diet & exercise to improve glycemic control in adults with diabetes mellitus type 2 - may be use in combination with other oral hypoglycemic agents including metformin, glimepiride, &/or pioglitazone - safe for patients > 70 years of age not taking a sulfonylurea [6] - add-on therapy to insulin in patients with type 2 diabetes [5] * neither cardiovascular benefits or cardiovascular harms [8] Contraindications: - avoid in combination with sulfonylurea [6] - has not been studied in combination with insulin Dosage: - 5 mg PO QD - may be taken with or without food - no dosage adjustment with renal insufficiency [3,7] Tabs: 5 mg Dosage adjustment in renal failure: - chronic renal failure stage 4 [10] Adverse effects: - nasopharyngitis - hypoglycemia [7] - pancreatitis (0.2%) Drug interactions: - increased risk of hypoglycemia when used in combination with sulfonylurea Mechanism of action: 1) dipeptidyl peptidase-4 inhibitor 2) inhibits incretin catabolism 3) enhances incretin system Cllinical trials: - non-inferior to glimepiride as add-on to metformin [ 4] - non-inferior to sulfonylurea for cardiovascular risk, hypoglycemia is less, but cost is much higher [9]

Interactions

drug adverse effects of hypoglycemic agents

General

gliptin; dipeptidyl peptidase-4 inhibitor; DPP-4 inhibitor

References

  1. FDA NEWS RELEASE: May 2, 2011 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm253501.htm
  2. Highlight linigliptin of prescribing information http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf
  3. Prescriber's Letter 18(6): 2011 New Drug: Tradjenta (Linagliptin) Detail-Document#: 270604 (subscription needed) http://www.prescribersletter.com
  4. Gallwitz B et al 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial The Lancet, Early Online Publication, 28 June 2012 PMID: 22748821 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960691-6/fulltext - Scheen AJ and Paquot N Gliptin versus a sulphonylurea as add-on to metformin The Lancet, Early Online Publication, 28 June 2012 PMID: 22748818 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60859-9/fulltext
  5. Physician's First Watch, Aug 27 2012 Massachusetts Medical Society http://www.jwatch.org - FDA approves updated prescribing information for Tradjenta (linagliptin) tablets for add-on therapy to insulin in adults with type 2 diabetes http://newsroom.lilly.com/releasedetail.cfm?ReleaseID=701013
  6. Barnett AH et al. Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: A randomised, double-blind, placebo-controlled trial. Lancet 2013 Aug 13 PMID: 23948125
  7. Neumiller JJ1, Setter SM. Review of linagliptin for the treatment of type 2 diabetes mellitus. Clin Ther. 2012 May;34(5):993-1005. PMID: 22440191
  8. Rosenstock J, Perkovic V, Johansen OE et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: The CARMELINA randomized clinical trial. JAMA 2018 Nov 9; PMID: 30418475 https://jamanetwork.com/journals/jama/fullarticle/2714646 - McGuire DK, Alexander JH, Johansen OE et al. Linagliptin effects on heart failure and related outcomes in individuals with type 2 diabetes mellitus at high cardiovascular and renal risk in CARMELINA. Circulation 2018 Nov 11 Not indexed in PubMed https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.038352
  9. Rosenstock J et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: The CAROLINA randomized clinical trial. JAMA 2019 Sep 19; 322:1155 PMID: 31536101 https://jamanetwork.com/journals/jama/article-abstract/2751398
  10. NEJM Knowledge+ Endocrinology

Component-of

empagliflozin/linagliptin empagliflozin/linagliptin/metformin (Trijardy XR) linagliptin/metformin (Jentadueto XR)