Companies: Boehringer Ingelheim and Lilly
Pharmacologic class: Dipeptidyl peptidase-4 inhibitor (DPP-4) + biguanide
Active ingredients: Linagliptin, metformin HCl; 2.5 mg/500 mg, 2.5 mg/850 mg, 2.5 mg/1,000 mg; tablets.
Indication: Adjunct to diet and exercise in type 2 diabetes when treatment with both linagliptin and metformin is appropriate.
Pharmacology: Jentadueto is an antidiabetic product that combines linagliptin, a DPP-4 inhibitor, and extended-release metformin, a biguanide. Linagliptin slows the inactivation of incretin hormones, increasing their levels in the blood, leading to reduced fasting and postprandial glucose levels in a glucose-dependent manner. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Clinical trials: The coadministration of linagliptin and metformin was studied in type 2 diabetes patients inadequately controlled on diet and exercise and in combination with sulfonylurea.
There have been no clinical efficacy studies conducted with Jentadueto; however, bioequivalence of Jentadueto to linagliptin and metformin coadministered as individual tablets was demonstrated in healthy subjects.
Adults: Individualize. Take b.i.d. with meals. Previously not on metformin: initially 2.5 mg/500 mg b.i.d. Previously on metformin: Start with 2.5 mg linagliptin and current dose of metformin b.i.d. Previously on linagliptin and metformin: switch on mg/mg basis. Maximum 2.5 mg/1000mg b.i.d.
Children: Not recommended.
Contraindications: Renal impairment (serum creatinine ≥1.5 mg/dL [men], ≥1.4 mg/dL [women], or abnormal creatinine clearance). Metabolic acidosis, diabetic ketoacidosis.
Warnings/Precautions: Not for treating type 1 diabetes. Confirm normal renal function before starting; monitor (especially in patients aged 80 years and older). Avoid in hepatic disease. Discontinue if lactic acidosis, shock, acute congestive heart failure or MI, sepsis, or hypoxemia occurs. Suspend therapy if dehydration occurs or before surgery. Monitor hepatic function, hematology (especially serum vitamin B12 in susceptible patients). Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, or alcohol intoxication: increased risk of hypoglycemia. Concomitant intravascular iodinated contrast agents (suspend during and for 48 hours after use). Pregnancy (Category B). Nursing mothers: not recommended.
Interactions: Antagonized by strong P-gp or CYP3A4 inducers (e.g., rifampin); consider alternatives to linagliptin if used in combination. Concomitant sulfonylurea: may need lower dose of sulfonylurea to reduce risk of hypoglycemia. Cationic drugs eliminated by renal tubular secretion (e.g., amiloride, cimetidine, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin): may increase metformin levels. Avoid excessive alcohol intake (potentiates effects of metformin on lactate). Increased risk of lactic acidosis with topiramate, other carbonic anhydrase inhibitors (e.g., zonisamide, acetazolamide, dichlorphenamide). Diuretics, steroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, sympathomimetics, calcium channel blockers, isoniazid, nicotinic acid, others may cause hyperglycemia. Concomitant insulin: not studied.
Adverse reactions: Nasopharyngitis, diarrhea; hypoglycemia, hypersensitivity, cough, decreased appetite, nausea, vomiting, pruritus, pancreatitis.
How supplied: Tabs—60, 180, 2,000
For more information, call 800.243.0127 or visit www.Jentadueto.com.