Linatab-M
Generic Name
Linagliptin + Metformin Hydrochloride
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| linatab m 25 mg tablet | ৳ 14.00 | ৳ 140.00 |
Description
Overview of the medicine
Linatab-M (Linagliptin + Metformin) is an oral antidiabetic medication used to improve glycemic control in adults with type 2 diabetes mellitus. Linagliptin is a DPP-4 inhibitor, and Metformin is a biguanide. They work synergistically to lower blood glucose levels.
Uses & Indications
Dosage
Adults
Typically, one tablet twice daily with meals. The dose should be individualized based on the patient's current regimen, effectiveness, and tolerability. Starting dose for Linagliptin/Metformin fixed-dose combination should be Linagliptin 2.5 mg/Metformin 500 mg twice daily.
Elderly
Dose adjustment may be necessary based on renal function.
Renal_impairment
Metformin is contraindicated in severe renal impairment (eGFR <30 mL/min/1.73m²). Dose adjustment required for moderate impairment; linagliptin does not require renal dose adjustment.
How to Take
Take orally with meals to reduce gastrointestinal side effects associated with metformin. Swallow the tablet whole; do not crush, cut, or chew.
Mechanism of Action
Linagliptin inhibits the DPP-4 enzyme, which prolongs the activity of incretin hormones (GLP-1 and GIP), leading to increased insulin synthesis and release and decreased glucagon secretion. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Pharmacokinetics
Onset
Within hours for blood glucose lowering.
Excretion
Linagliptin: Primarily via enterohepatic system (80% fecal, 5% renal). Metformin: Excreted unchanged in the urine.
Half life
Linagliptin: Terminal half-life approx. 120 hours. Metformin: Plasma elimination half-life approximately 6.2 hours.
Absorption
Linagliptin: Rapidly absorbed, absolute bioavailability approx. 30%. Metformin: Absolute bioavailability of a 500 mg tablet is approximately 50-60%.
Metabolism
Linagliptin: Minor metabolism. Metformin: Not metabolized in the liver.
Side Effects
Contraindications
- Hypersensitivity to linagliptin, metformin, or any component of the formulation.
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.
- Severe renal impairment (eGFR <30 mL/min/1.73m²).
- Acute conditions with potential for renal impairment (e.g., dehydration, severe infection, shock).
- Hepatic impairment.
- Acute heart failure, unstable angina, myocardial infarction.
- Alcohol abuse.
Drug Interactions
Metformin with Alcohol
Potentiates the effect of metformin on lactate metabolism, increasing the risk of lactic acidosis.
Linagliptin with Rifampicin
Decreases linagliptin exposure, reducing its efficacy.
Metformin with Iodinated Contrast Agents
Temporarily discontinue metformin at the time of or prior to an iodinated contrast imaging procedure in patients with impaired renal function, or if an acute change in renal function is anticipated.
Metformin with Carbonic Anhydrase Inhibitors
May increase the risk of lactic acidosis.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Linagliptin: No significant toxicity expected. Management is supportive. Metformin: Lactic acidosis is a serious complication of metformin overdose. Management involves hemodialysis to remove metformin and correct acidosis.
Pregnancy & Lactation
Pregnancy: Category B for linagliptin, Category B for metformin. Generally not recommended unless clearly needed and benefits outweigh risks. Lactation: Metformin is excreted into breast milk. Linagliptin excretion into breast milk is unknown. Weigh benefits vs. risks.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months
Availability
Pharmacies, Hospitals
Approval Status
Approved by FDA/DGDA
Patent Status
Generic versions available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of linagliptin and metformin in patients with type 2 diabetes, both as monotherapy and in combination. These trials typically assessed HbA1c reduction, fasting plasma glucose, and postprandial glucose levels.
Lab Monitoring
- Renal function (eGFR) prior to initiation and annually thereafter.
- Glycosylated Hemoglobin (HbA1c) every 3-6 months.
- Vitamin B12 levels periodically.
- Liver function tests if clinically indicated.
Doctor Notes
- Emphasize importance of renal function monitoring, especially before initiating and during metformin therapy.
- Counsel patients on symptoms of lactic acidosis and hypoglycemia.
- Consider temporarily discontinuing metformin in patients undergoing radiologic studies with iodinated contrast or surgical procedures.
- Advise on lifestyle modifications including diet and exercise.
Patient Guidelines
- Take this medicine as directed by your doctor, preferably with meals.
- Do not stop taking this medicine without consulting your doctor.
- Be aware of symptoms of hypoglycemia (e.g., sweating, trembling, confusion) especially if also taking insulin or sulfonylurea.
- Report any signs of lactic acidosis (e.g., unusual muscle pain, difficulty breathing, unusual stomach discomfort) immediately.
- Inform your doctor about all medications, supplements, and herbal products you are taking.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your next dose at the regular time. Do not double the dose.
Driving Precautions
This medicine generally does not impair driving ability. However, if you experience symptoms of hypoglycemia, do not drive or operate machinery.
Lifestyle Advice
- Maintain a balanced diet and regular exercise regimen.
- Monitor blood glucose levels regularly as advised by your doctor.
- Limit alcohol intake.
- Stay well-hydrated.
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