Linagliptin (Trajenta)
✅ 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.
ℹ️ About
- Linagliptin (Trajenta) — DPP-4 inhibitor (“gliptin”).
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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
Revisions
