Antidiabetic Agent; Dipeptidyl Peptidase 4 (DPP-4) Inhibitor; Biguanide
“ALERT: US Boxed Warning
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL. Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (eg, carbonic anhydrase inhibitors such as topiramate), ≥65 years, having a radiological study with contrast, surgery and other procedures, hypoxic states (eg, acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high-risk groups are provided in the full prescribing information.
If metformin-associated lactic acidosis is suspected, immediately discontinue metformin and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does it Work
Incretin hormones such as glucagon-like peptide-1 (GLP-1) regulate glucose by increasing the production and release of insulin from pancreatic beta cells while also decreasing glucagon secretion from pancreatic alpha cells. Decreasing glucagon results in less glucose production by the liver. Incretin hormones are normally released by the intestines and production is stimulated by food. Incretins are inactivated by DPP-4. Linagliptin inhibits DPP-4 thereby raising incretin levels and resulting in lower blood glucose.
Metformin is believed to exhibit multiple mechanisms of action which ultimately decreases gluconeogenesis (hepatic glucose production) in the liver, decreases intestinal absorption of glucose, and improves the insulin sensitivity of muscle which increases peripheral glucose uptake and overall utilization. Metformin also exhibits an anti-androgenic effect in women with insulin resistance
Indications For Use
Linagliptin+Metformin, Jentadueto is officially indicated for Diabetes mellitus Type 2.
Before starting Linagliptin+Metformin, Jentadueto makes sure your physician is aware of any allergies, medications you currently take, if you have a history of lactic acidosis, if you have kidney disease, liver disease, cardiovascular disease, a history of pancreatitis, are pregnant or breastfeeding.
Total daily dosage of 5mg daily of Linagliptin plus their daily dosage of metformin, unless they are not already on metformin in which case 1gram daily should be the initial total daily metformin dosage. Division of dosages depends on required daily metformin dosage and patient tolerance. Linagliptin can be dosed once daily and metformin should be divided into two or three daily dosages.
Pharmacist Tips On Using
How to Take Linagliptin+Metformin, Jentadueto: Follow instructions provided by physician/pharmacy label, swallow whole, take consistently at the same time each day with food unless otherwise directed, store at room temperature
You Need to Avoid: Do not use for Type 1 Diabetes Mellitus. Avoid excessive acute or chronic alcohol consumption.
Hypoglycemia, increased uric acid, increased serum lipase, nasopharyngitis, cough, diarrhea, nausea, vomiting, flatulence, infection
Note this is not a complete list of side effects, only common ones
Frequently Asked Questions
What is hypoglycemia?
Hypoglycemia is a condition of low blood sugar (>3.9mmol/L-Canada; 70mg/dL-US) which is considered a medical emergency whereas hyperglycemia is a slowly progressive condition. It generally occurs with irregularities in diet, exercise, and medications in diabetic patients. It is preferably treated with simple sugars such as dextrose; regular table sugar can work but is slower acting as it needs to be digested and if blood sugar is extremely low this delay can be a problem. Hypoglycemia has a large host of progressive symptoms from hunger, headache, nausea, sweating, palpitations, mood swings, irritability to seizure, coma and in severe cases, death.