Linagliptin

About Linagliptin

Linagliptin blocks DPP-4, an enzyme that breaks down the gut hormones GLP-1 and GIP, so the pancreas releases more insulin after meals and less glucagon. The effect on blood sugar is modest, and on its own it rarely causes hypoglycemia. It is one 5 mg tablet a day, with or without food, for adults with type 2 diabetes, alone or with metformin, a sulfonylurea, insulin or other medicines; it does not work in type 1 diabetes.

Unlike sitagliptin, whose dose is lowered when kidney function falls, linagliptin is taken at the same dose whatever the kidney or liver function. For people with normal kidneys that advantage matters less, and several other drugs in the class, sitagliptin included, are now sold as generics.

Stuffy nose and sore throat are the most common side effects. The label warns of pancreatitis, sometimes fatal, so severe, persistent stomach pain that may spread to the back means stopping and calling the prescriber. It also warns of serious allergic reactions, disabling joint pain, a blistering skin condition called bullous pemphigoid, and heart failure, which has been seen with other drugs in the class. With insulin or a sulfonylurea, lows are more likely and those doses may be lowered. There is no boxed warning. Brand combinations add metformin (Jentadueto, Jentadueto XR), empagliflozin (Glyxambi) or both (Trijardy XR).

Taking Linagliptin

How to take it

One tablet once a day, with or without food, at about the same time each day. Tell your doctor or dentist before surgery, since surgery, illness and fever can change blood sugar and the medicine you need.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in the original container, tightly closed, away from heat and moisture.

Interactions to know about

Rifampin and similar drugs that speed up its breakdown can make it less effective, and the label strongly recommends another treatment in that case; St. John’s wort may interact too. Lows are more likely with insulin or a sulfonylurea such as glipizide. Get medical help for swelling of the face or throat, blistering skin or severe stomach pain.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Linagliptin differs from pharmacy to pharmacy

With only the brand on sale, every pharmacy pays a similar wholesale price, so quotes differ by mark-up and fees rather than by supplier, and a brand price leaves more room for mark-up than a generic. Once generics arrive, quotes are likely to scatter for a while as pharmacies switch suppliers at different speeds. The combination tablets are priced separately and follow their own generic timelines.

Ways to pay less for Linagliptin without insurance

• Ask the prescriber whether a generic DPP-4 inhibitor such as sitagliptin would suit you, with its dose set for your kidney function.
• If you have no insurance, or have Medicare, and a limited income, ask about Boehringer Ingelheim’s patient assistance program, which provides the medicine free to people who qualify.
• Ask the prescriber to allow substitution, so a generic can be dispensed as soon as the pharmacy stocks it.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Linagliptin

1. 1.Is a generic available yet?
2. 2.Do my other diabetes medicines need adjusting to avoid lows?
3. 3.Which symptoms should make me stop and call?
4. 4.Would another DPP-4 inhibitor suit my kidney function?
5. 5.Is the metformin combination cheaper here than two separate prescriptions?

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