Makindo Medical Notes

✅ Low hypoglycaemia risk when used alone (hypos mainly if combined with insulin / sulfonylurea).
✅ Usually weight neutral.
⭐ Renal impairment advantage: linagliptin typically needs no dose adjustment (useful in CKD).
⚠️ Pancreatitis: rare reports with gliptins — counsel on symptoms and stop if suspected.

About

• Linagliptin (Trajenta) — DPP-4 inhibitor (“gliptin”).
• Always confirm indications, renal/hepatic advice, contraindications, and interactions in the BNF monograph.

Mode of action

• Inhibits DPP-4 → increases endogenous incretins (GLP-1/GIP).
• Produces glucose-dependent ↑ insulin secretion and ↓ glucagon (hence low hypo risk unless combined with insulin/SU).

Indications

• Type 2 diabetes as monotherapy (when metformin inappropriate) or add-on therapy (including with insulin) when targets not met.
• Often favoured in CKD where other gliptins require dose reduction.

Dose

• Linagliptin 5 mg once daily (with or without food).
• Renal impairment: typically no dose adjustment required — still monitor renal function as part of diabetes care.

Prescribing advice

• DPP-4 inhibitors are generally weight neutral and have low hypoglycaemia risk.
• If combined with sulfonylurea or insulin, consider reducing those doses to reduce hypoglycaemia risk.
• Formulary note: local first-line “gliptin” choice varies; linagliptin is commonly preferred when renal function is poor.

Interactions

• See BNF for full list.
• Enzyme inducers (e.g. rifampicin, carbamazepine, phenytoin, phenobarbital) may reduce linagliptin exposure/effect.

Cautions

• Pancreatitis: advise to seek urgent review for persistent severe abdominal pain (sometimes radiating to the back).
• Use clinical judgement in severe intercurrent illness (dehydration, sepsis) and reassess diabetes regimen as needed.

Contraindications

• Diabetic ketoacidosis / type 1 diabetes (not indicated).
• Known serious hypersensitivity to linagliptin.

Side effects

• Headache, nasopharyngitis/URTI-type symptoms, GI upset (variable).
• Stop linagliptin if pancreatitis is suspected and investigate.

References

• BNF: Linagliptin

Revisions