- Stock: In Stock
- Brand: Unimed Unihealth MFG. Ltd.
- Product ID: Linagliptin
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Adlina 5mg Tablet — Linagliptin
Generic Name: Linagliptin 5mg
Manufacturer: Beximco Pharmaceuticals Ltd.
Drug Class: DPP-4 Inhibitor (Gliptin) — Oral Antidiabetic Agent
Dosage Form: Tablet
Prescription Status: Prescription Only (Rx)
Mechanism of Action
Linagliptin is a highly selective, potent inhibitor of dipeptidyl peptidase-4 (DPP-4), the enzyme responsible for rapid inactivation of the incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). By inhibiting DPP-4, linagliptin increases active incretin levels, leading to:
- Glucose-dependent stimulation of insulin secretion from pancreatic beta cells
- Glucose-dependent suppression of glucagon from alpha cells
- Reduced hepatic glucose output
- Slowed gastric emptying (minor effect)
Because the mechanism is glucose-dependent, linagliptin does not cause hypoglycaemia when used as monotherapy — insulin is only released when blood glucose is elevated.
Unique property: Linagliptin is primarily excreted via the bile/gut (non-renal elimination), making it the only DPP-4 inhibitor that does not require dose adjustment in renal impairment — including patients on dialysis.
Clinical Advantages of Linagliptin
- No dose adjustment required in any stage of CKD — uniquely suitable for diabetic nephropathy patients
- Weight-neutral — does not cause weight gain
- Very low intrinsic hypoglycaemia risk as monotherapy
- Once-daily dosing — independent of meal timing
- CARMELINA trial: cardiovascular and renal safety demonstrated
- Can be used in elderly patients with renal impairment without dose adjustment
Indications
- Type 2 Diabetes Mellitus (T2DM) in adults
- Monotherapy when metformin is contraindicated or not tolerated
- Add-on to metformin, sulphonylureas, SGLT-2 inhibitors, or basal insulin
- Particularly suited to patients with chronic kidney disease (CKD) — any stage
- Elderly patients where hypoglycaemia risk is a concern
Dosage and Administration
| Population | Dose | Notes |
|---|---|---|
| Standard dose | 5mg once daily | With or without food, any time of day |
| Renal impairment (any stage, including dialysis) | 5mg once daily — no adjustment needed | Unique advantage vs. other DPP-4 inhibitors |
| Hepatic impairment | 5mg once daily (use with caution in severe) | Limited data in severe hepatic impairment |
| Elderly patients | 5mg once daily — no adjustment | Preferred in elderly with CKD |
Glycaemic Targets with Linagliptin
| Parameter | General Target | Monitoring Frequency |
|---|---|---|
| HbA1c | <7.0% (individualise for elderly/CKD) | Every 3 months (6-monthly if stable) |
| Fasting blood glucose | 4.4–7.2 mmol/L (80–130 mg/dL) | Regular self-monitoring |
| 2-hr postprandial glucose | <10 mmol/L (<180 mg/dL) | As directed by physician |
| Renal function (eGFR, urine ACR) | Monitor CKD progression | Annually (or more frequent if CKD) |
Contraindications
- Type 1 Diabetes Mellitus
- Diabetic ketoacidosis (DKA)
- Hypersensitivity to linagliptin or any DPP-4 inhibitor
- History of serious hypersensitivity reactions (anaphylaxis, angioedema, exfoliative skin conditions) to any DPP-4 inhibitor
Warnings and Precautions
- Pancreatitis: Rare cases reported with DPP-4 inhibitors. Discontinue if acute pancreatitis is suspected (severe persistent abdominal pain).
- Heart failure: Consider risks in patients with established heart failure (CARMELINA trial: no increase in hospitalisation for HF).
- Joint pain: Severe, disabling arthralgia reported rarely — discontinue if occurs.
- Bullous pemphigoid: Rare skin blistering condition reported with DPP-4 inhibitors — seek dermatological evaluation.
- Hypoglycaemia with sulphonylurea or insulin: When used in combination, reduce sulphonylurea or insulin dose as appropriate.
Drug Interactions
| Drug / Class | Interaction |
|---|---|
| Sulphonylureas or insulin | Increased hypoglycaemia risk — reduce sulphonylurea/insulin dose |
| Rifampicin (CYP3A4/P-gp inducer) | Reduces linagliptin exposure — reduced efficacy; avoid if possible |
| Strong P-gp inhibitors (e.g. ritonavir) | Increase linagliptin exposure slightly — unlikely clinically significant |
| Metformin, SGLT-2 inhibitors | No clinically significant interaction — commonly combined |
Side Effects
| System | Side Effects | Frequency |
|---|---|---|
| Respiratory | Nasopharyngitis, upper respiratory tract infection | Common |
| GI | Diarrhoea, nausea | Uncommon |
| Metabolic | Hypoglycaemia (only when combined with SU/insulin) | Uncommon |
| GI | Pancreatitis (acute) | Rare |
| MSK | Severe arthralgia | Rare |
| Immune | Hypersensitivity, angioedema, anaphylaxis | Very rare |
| Skin | Bullous pemphigoid | Very rare |
Storage
Store below 30°C. Protect from moisture and direct sunlight. Keep out of reach of children.
Medical Disclaimer
The information provided here is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Adlina (Linagliptin 5mg) must only be used under the supervision of a qualified physician. Discontinue immediately and seek medical help if you experience signs of pancreatitis, angioedema, or severe skin reactions. DiabetesStore.com.bd does not endorse self-medication.
