Linagliptin

Linagliptin is a dipeptidyl peptidase-4 (dpp-4) inhibitor — oral antidiabetic medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

Linagliptin is used to improve blood sugar control in adults with type 2 diabetes mellitus, alongside diet and exercise. Your doctor may prescribe it:

• Alone, when metformin is unsuitable — for example due to kidney problems or intolerance
• Together with metformin, a sulfonylurea, pioglitazone, an SGLT2 inhibitor or insulin when combination therapy is needed

Because of the way linagliptin is cleared from the body, it is often favoured for diabetic patients with chronic kidney disease. It is not used for type 1 diabetes or diabetic ketoacidosis. Your doctor will decide its exact place in your treatment plan.

The usual dose of Linagliptin is 5 mg once daily, taken at any fixed time, with or without food. A practical advantage of Linagliptin is that no routine dose change is needed in kidney or liver disease — but that judgement always belongs to your doctor, who knows your full medical picture.

• Take it at about the same time every day to build a habit.
• If you miss a dose, take it as soon as you remember the same day; if it is almost time for the next dose, skip the missed one.
• Never take two doses in one day, and never stop or adjust the dose on your own.

Linagliptin is generally well tolerated. Possible side effects include:

• Blocked or runny nose, sore throat, cough
• Headache or dizziness
• Constipation, nausea or mild stomach discomfort
• Joint pain, which is occasionally severe
• Low blood sugar, mainly when combined with a sulfonylurea or insulin

Rare but serious effects include pancreatitis — severe, persistent stomach pain that may radiate to the back, often with vomiting — and a blistering skin condition called bullous pemphigoid, as well as serious allergic reactions with swelling of the face, lips or throat. Stop the medicine and seek medical care urgently if any of these develop.

Before and during treatment with Linagliptin:

• Tell your doctor if you have ever had pancreatitis, gallstones or very high triglycerides.
• If you also use insulin or a sulfonylurea, learn the signs of low blood sugar and keep glucose or sweets nearby; those doses may need lowering.
• Report any new severe stomach pain, blistering rash or unusual joint pain promptly.
• Continue routine check-ups — blood sugar, HbA1c and the kidney tests your doctor schedules — even though the linagliptin dose itself rarely changes.

Linagliptin supplements, but never replaces, a diabetic diet and regular physical activity, and it must not be stopped on your own even when readings look good.

Tell your doctor and pharmacist about all your medicines, including herbal and over-the-counter products. Notable interactions with Linagliptin:

• Rifampicin (a tuberculosis antibiotic) and other strong enzyme inducers such as carbamazepine, phenytoin and St John's wort can markedly reduce the effect of linagliptin — your doctor may choose a different diabetes medicine while these are needed.
• Insulin and sulfonylureas raise the risk of low blood sugar when combined with Linagliptin; their doses may be reduced.
• Steroids and some diuretics can push blood sugar up, so your control may need re-checking when they are started or stopped.

Do not take Linagliptin if:

• You are allergic to Linagliptin or any other ingredient of the product
• You previously had a serious reaction — anaphylaxis, angioedema or a severe skin reaction — to linagliptin or another DPP-4 inhibitor

Linagliptin is not a treatment for type 1 diabetes or diabetic ketoacidosis. If pancreatitis is suspected during treatment, the medicine should be stopped and not restarted without specialist review. When unsure whether Linagliptin is appropriate for you, always confirm with your doctor or pharmacist before taking it.

There is limited experience with Linagliptin in human pregnancy, so it is best avoided unless your doctor judges it clearly necessary. Pregnant women with diabetes are usually switched to insulin, which has the strongest safety record for the baby. If you become pregnant or plan a pregnancy while taking Linagliptin, inform your doctor early — do not abruptly stop diabetes treatment, because uncontrolled sugar harms both mother and baby.

It is not known whether linagliptin passes into human breast milk. Discuss with your doctor before breastfeeding; an alternative medicine may be preferred during this period.

Store Linagliptin below 30°C in a cool, dry place, away from direct sunlight and moisture. Keep the in its original blister or container until you take it, and avoid storing medicines in humid places such as the bathroom or kitchen.

• Keep all medicines out of the reach and sight of children.
• Do not use the medicine after the expiry date printed on the pack.
• Do not throw unused medicine into household waste or drains; ask your pharmacist about safe disposal.