Empagliflozin, Linagliptin and Metformin

Hypoglycaemic excluding Insulin · Dipeptidyl peptidase-4 inhibitor/Reversible inhibitor of sodium-glucose co-transporter 2 (SGLT2)

Indications

Type 2 diabetes mellitus with established cardiovascular disease.

Dosage

Adults: Take once daily in the morning. Children: Not recommended.

Adverse Effects

Lactic acidosis, pancreatitis, heart failure, hypotension, ketoacidosis, acute kidney injury, urosepsis and pyelonephritis, hypoglycaemia with concomitant use with insulin and insulin secretagogues, necrotizing fasciitis of the perineum (Fournier’s Gangrene), genital mycotic infections.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Caution advised or effect undetermined. Contraindications: Severe renal impairment (eGFR <30 mL/min/1.73m2), end-stage renal disease, dialysis, hepatic impairment, history of liver disease, alcoholism, heart failure, acute or chronic metabolic acidosis, including diabetic ketoacidosis. Precautions: Assess renal function prior to starting treatment. Elderly.

Interactions

Topiramate or other carbonic anhydrase inhibitors (e.g. zonisamide, acetazolamide or dichlorphenamide). OCT2/MATE inhibitors (e.g. ranolazine, vandetanib, dolutegravir, and cimetidine). Diuretics. Insulin secretagogue (e.g. sulfonylurea). Insulin. SGLT2 inhibitors. Rifampin.

Advice to Patient

Take with meals. Swallow whole tab. Do not split, crush, dissolve or chew. Avoid alcohol.

Pharmacokinetics

EMPAGLIFLOZIN: Metabolism: Hepatic. Half-life elimination: 12.4 hrs. Time to peak: 1.5 hrs. Excretion: Urine (54.4%). Faeces (41.2%). LINAGLIPTIN: Metabolism: A small fraction is absorbed and metabolized to a pharmacologically inactive metabolite. Bioavailability: Absolute: Approx. 30%. Excretion: Urine (5%) or Enterohepatic system (80%). METFORMIN: Onset of action: Within days, max effects up to 2 wks. Metabolism: Not metabolized by the liver. Bioavailability: Absolute: Fasting: 50%-60%. Half-life elimination: Plasma: 4-9 hrs. Blood: Approx. 17.6 hrs. Time to peak, serum: Immediate release: 2-3 hrs. Extended release: 7 hrs. (Range: 4-8 hrs). Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.