Linagliptin + Metformin Hydrochloride

Linagliptin + Metformin Hydrochloride is a antidiabetic combination (dpp-4 inhibitor + biguanide) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• Type 2 diabetes mellitus in adults, alongside diet and exercise:
• When metformin alone does not achieve sugar targets
• When a patient already takes linagliptin and metformin as separate tablets — one combined tablet is more convenient
• With other diabetes medicines or insulin if the doctor decides

Not for type 1 diabetes or diabetic ketoacidosis.

Possible side effects include:

• Nausea, loose stools, gas, metallic taste — mostly from metformin, usually settling within weeks when taken with food
• Sore throat, stuffy nose (nasopharyngitis)
• Low blood sugar (hypoglycaemia) — mainly when combined with insulin or sulfonylureas
• Reduced vitamin B12 over years of metformin use
• Joint pain; rarely severe (linagliptin)
• Rare: acute pancreatitis — severe persistent upper-stomach pain radiating to the back; stop and seek care
• Very rare: lactic acidosis (metformin) — unusual muscle pain, fast breathing, extreme weakness with severe illness or dehydration; this is an emergency
• Skin blistering (bullous pemphigoid, rare)

• Your doctor will check kidney function before starting and periodically — metformin needs dose adjustment or stopping if kidneys weaken.
• Tell your doctor before any X-ray/CT scan with contrast dye or any surgery — metformin is usually paused around these.
• During severe vomiting, diarrhoea, fever or inability to eat or drink, contact your doctor — metformin may need to be paused temporarily (sick-day rule).
• Limit alcohol — it raises the risk of lactic acidosis and low sugar.
• Report severe persistent abdominal pain (pancreatitis warning) at once.
• Long-term users should have vitamin B12 checked occasionally.
• Carry glucose or sweets if you also use insulin or sulfonylureas.

• Insulin and sulfonylureas (glimepiride, gliclazide): higher risk of low blood sugar — doses may need lowering
• Rifampicin: strongly reduces linagliptin's effect
• Carbamazepine, phenytoin, phenobarbital: may weaken linagliptin
• Iodinated contrast dye: pause metformin around the scan as directed
• Alcohol: increases lactic acidosis and hypoglycaemia risk
• Corticosteroids, thiazide diuretics, some antipsychotics: raise blood sugar — control may need re-checking
• Cimetidine and some kidney-transported drugs: can raise metformin levels

• Allergy to linagliptin, metformin or any component
• Severe kidney impairment (eGFR below 30 mL/min)
• Metabolic acidosis or diabetic ketoacidosis
• Severe infection, shock, dehydration or conditions with low tissue oxygen (recent heart attack, severe heart or respiratory failure)
• Severe liver disease or alcohol abuse
• History of pancreatitis caused by a DPP-4 inhibitor (use with caution per doctor)

Pregnancy: This combination is generally not recommended in pregnancy — there are not enough data for linagliptin. Pregnant women with diabetes are usually managed with insulin (and sometimes metformin alone) under specialist care. Tell your doctor as soon as you become pregnant or plan to conceive so treatment can be switched safely.

Lactation: Metformin passes into breast milk in small, usually harmless amounts, but data for linagliptin are lacking, so the combination is best avoided while breastfeeding. Your doctor will choose a suitable regimen.

Store below 30°C in a dry place, protected from light and moisture. Keep in the original pack and out of the reach of children. Do not use after the expiry date.