Linamet-ER
Generic Name
Linagliptin + Metformin Hydrochloride Extended-Release Tablet
Manufacturer
Eskayef Pharmaceuticals Ltd.
Country
Bangladesh
Loading images...
Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| linamet er 25 mg tablet | ৳ 17.00 | ৳ 102.00 |
Description
Overview of the medicine
Linamet-ER is a combination oral antidiabetic medication containing Linagliptin and Metformin Extended-Release. It is used to improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise.
Uses & Indications
Dosage
Adults
The usual starting dose is Linagliptin 2.5 mg / Metformin 500 mg ER once daily with the evening meal. Dose may be titrated up to a maximum of Linagliptin 2.5 mg / Metformin 1000 mg ER twice daily, or Linagliptin 5 mg / Metformin 1000 mg ER once daily, based on individual response and tolerability.
Elderly
No specific dose adjustment is required based on age, but renal function should be monitored due to increased risk of renal impairment in elderly patients.
Renal_impairment
Metformin is contraindicated in severe renal impairment (eGFR <30 mL/min/1.73m²). Dose adjustment for Metformin is required for moderate renal impairment (eGFR 30-45 mL/min/1.73m²), e.g., maximum 1000 mg/day. Linagliptin does not require dose adjustment in renal impairment.
How to Take
Take orally, once or twice daily with meals as directed by your physician. Swallow the extended-release tablet whole; do not crush, cut, or chew it.
Mechanism of Action
Linagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that increases incretin hormone levels (GLP-1 and GIP), leading to glucose-dependent increases in insulin release and decreases in glucagon secretion. Metformin is a biguanide that decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Pharmacokinetics
Onset
Linagliptin: within hours. Metformin: Glycemic effects usually observed within days, full effect over weeks.
Excretion
Linagliptin: Primarily biliary/fecal (~85%). Metformin: Primarily renal, excreted unchanged in urine.
Half life
Linagliptin: Terminal elimination half-life is long (>100 hours), but effective half-life for DPP-4 inhibition is ~12 hours. Metformin: Plasma elimination half-life is ~6.2 hours; blood half-life is ~17.6 hours.
Absorption
Linagliptin: ~30% oral bioavailability. Metformin ER: Incomplete absorption, ~50-60% absolute bioavailability.
Metabolism
Linagliptin: Minimally metabolized. Metformin: Not metabolized.
Side Effects
Contraindications
- Hypersensitivity to Linagliptin, Metformin, or any component of the formulation.
- Severe renal impairment (eGFR <30 mL/min/1.73m²).
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis (DKA), with or without coma.
- Acute conditions with potential for renal function impairment (e.g., dehydration, severe infection, shock).
- Acute or chronic disease which may cause tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction, shock).
- Hepatic impairment (for metformin).
- Acute alcohol intoxication.
Drug Interactions
Alcohol
Increases the risk of lactic acidosis (Metformin).
Sulfonylureas / Insulin
Increased risk of hypoglycemia when co-administered with Linagliptin and Metformin.
Iodinated Contrast Agents
Temporarily discontinue Metformin before or at the time of the procedure and for 48 hours afterward to avoid lactic acidosis.
Diuretics (e.g., Thiazides, Loop Diuretics)
May enhance metformin's blood glucose-lowering effects and increase risk of lactic acidosis.
Corticosteroids, Sympathomimetics, Thiazides
May decrease glycemic control.
Cationic Drugs (e.g., Cimetidine, Amiloride, Digoxin, Furosemide, Nifedipine, Trimethoprim, Vancomycin)
May increase Metformin concentration.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Metformin overdose may lead to lactic acidosis, which is a medical emergency requiring immediate treatment. Linagliptin overdose experience is limited, but expected to be minimal. Treatment is symptomatic and supportive; hemodialysis may be useful for Metformin removal.
Pregnancy & Lactation
Pregnancy Category B for Linagliptin, Category B for Metformin (animal studies have shown no risk, but human data are limited). Not recommended during pregnancy unless clearly needed. Use with caution during lactation; consult physician.
Side Effects
Contraindications
- Hypersensitivity to Linagliptin, Metformin, or any component of the formulation.
- Severe renal impairment (eGFR <30 mL/min/1.73m²).
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis (DKA), with or without coma.
- Acute conditions with potential for renal function impairment (e.g., dehydration, severe infection, shock).
- Acute or chronic disease which may cause tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction, shock).
- Hepatic impairment (for metformin).
- Acute alcohol intoxication.
Drug Interactions
Alcohol
Increases the risk of lactic acidosis (Metformin).
Sulfonylureas / Insulin
Increased risk of hypoglycemia when co-administered with Linagliptin and Metformin.
Iodinated Contrast Agents
Temporarily discontinue Metformin before or at the time of the procedure and for 48 hours afterward to avoid lactic acidosis.
Diuretics (e.g., Thiazides, Loop Diuretics)
May enhance metformin's blood glucose-lowering effects and increase risk of lactic acidosis.
Corticosteroids, Sympathomimetics, Thiazides
May decrease glycemic control.
Cationic Drugs (e.g., Cimetidine, Amiloride, Digoxin, Furosemide, Nifedipine, Trimethoprim, Vancomycin)
May increase Metformin concentration.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Metformin overdose may lead to lactic acidosis, which is a medical emergency requiring immediate treatment. Linagliptin overdose experience is limited, but expected to be minimal. Treatment is symptomatic and supportive; hemodialysis may be useful for Metformin removal.
Pregnancy & Lactation
Pregnancy Category B for Linagliptin, Category B for Metformin (animal studies have shown no risk, but human data are limited). Not recommended during pregnancy unless clearly needed. Use with caution during lactation; consult physician.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date
Availability
Available in pharmacies with a valid prescription
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Combination product patent protection varies; Metformin is generic, Linagliptin is proprietary (but generics of combination exist)
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have demonstrated the efficacy and safety of Linagliptin and Metformin combination in improving glycemic control in type 2 diabetes patients.
Lab Monitoring
- Renal function (eGFR) should be assessed before initiating treatment and at least annually thereafter. More frequent monitoring is recommended in elderly patients or those at risk of renal impairment.
- HbA1c levels to monitor glycemic control.
- Blood glucose levels (fasting and post-prandial).
- Vitamin B12 levels should be measured periodically in patients on long-term Metformin therapy.
Doctor Notes
- Assess renal function (eGFR) before initiation and periodically thereafter.
- Educate patients on symptoms of lactic acidosis and hypoglycemia.
- Advise patients to temporarily discontinue Metformin for procedures requiring iodinated contrast agents.
- Consider Vitamin B12 supplementation for long-term Metformin users.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor.
- Swallow the tablet whole; do not crush, cut, or chew it.
- Take it with a meal, usually the evening meal, to reduce stomach upset.
- Monitor your blood sugar regularly as advised by your doctor.
- Be aware of symptoms of hypoglycemia (low blood sugar) and lactic acidosis (e.g., unusual muscle pain, trouble breathing, stomach pain).
- Do not stop taking the medicine without consulting your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Linamet-ER, when taken alone, is unlikely to cause hypoglycemia and thus usually does not affect the ability to drive or use machines. However, if used in combination with other anti-diabetic medications (e.g., sulfonylureas or insulin) that are known to cause hypoglycemia, caution should be exercised.
Lifestyle Advice
- Follow a balanced diet plan recommended by your doctor or a dietitian.
- Engage in regular physical activity.
- Maintain a healthy weight.
- Limit alcohol consumption.
Alternative Medicines in Bangladesh
Similar medicines available in the market
Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
Other Medicines in Linamet-ER Brand
Other medicines available under the same brand name
