What are the dosing and treatment guidelines for Glyxambi (linagliptin and empagliflozin) in patients with type 2 diabetes?

From the Guidelines

Glyxambi is typically initiated at a dose of 10 mg empagliflozin/5 mg linagliptin taken once daily in the morning, with or without food, for patients with type 2 diabetes. For patients who need additional glycemic control and can tolerate the lower dose, the dosage may be increased to 25 mg empagliflozin/5 mg linagliptin once daily. No dose adjustment is needed for patients with mild to moderate renal impairment, but Glyxambi is not recommended for patients with severe renal impairment, end-stage renal disease, or on dialysis (eGFR less than 30 mL/min/1.73 m²) 1. Liver function should be assessed before starting treatment, and the medication should be used cautiously in patients with hepatic impairment. Glyxambi combines two antidiabetic mechanisms: empagliflozin is an SGLT2 inhibitor that reduces blood glucose by increasing urinary glucose excretion, while linagliptin is a DPP-4 inhibitor that increases incretin levels, stimulating insulin release and reducing glucagon secretion. Patients should be monitored for hypoglycemia, especially if used with insulin or insulin secretagogues, and should be advised about potential side effects including urinary tract infections, genital mycotic infections, and volume depletion 1. Adequate hydration should be maintained, and temporary discontinuation may be necessary during periods of reduced oral intake or fluid losses. Key considerations for the use of Glyxambi include:

• Monitoring renal function and adjusting the dose accordingly
• Assessing liver function before starting treatment
• Counseling patients on potential side effects and the importance of adequate hydration
• Regularly monitoring for hypoglycemia, especially when used with other antidiabetic medications. The most recent and highest quality study, 1, supports the use of Glyxambi for patients with type 2 diabetes, with a focus on cardiovascular risk reduction and management.

From the Research

Glyxambi Dosing and Treatment Guidelines

The dosing and treatment guidelines for Glyxambi (linagliptin and empagliflozin) in patients with type 2 diabetes are as follows:

• Glyxambi is a fixed-dose, once-daily tablet combining a sodium glucose co-transporter-2 (SGLT2) inhibitor with a dipeptidyl peptidase-4 (DPP-4) inhibitor 2.
• The recommended dosage is a combination of 10mg or 25mg empagliflozin with 5mg linagliptin 2.
• Glyxambi is served as an adjuvant to diet and exercise to improve glycemic control in adults with type 2 diabetes when both empagliflozin and linagliptin are appropriate treatments 2.

Mechanism of Action

The mechanism of action of Glyxambi involves:

• Empagliflozin removing glucose through the urine by blocking blood glucose re-absorption in the kidney 2, 3.
• Linagliptin exerting glucose-lowering activity by increasing hormones that stimulate the pancreas to produce more insulin and decreasing the levels of glucagon in the circulation 2, 4.

Efficacy and Safety

The efficacy and safety of Glyxambi have been demonstrated in several studies:

• Glyxambi has been shown to improve glycemic control, reduce body weight, and lower blood pressure without significant safety issues 2, 5, 6.
• The combination of empagliflozin and linagliptin has been found to be well tolerated, with a low risk of hypoglycemia 4, 5, 6.
• The most common adverse events associated with Glyxambi are increased urination, increased blood ketones, and genital infections 3, 6.

Patient Selection

Glyxambi is suitable for patients with type 2 diabetes who:

• Have an HbA1c value below 8.5% 4.
• Are treatment-naive or are using one oral antidiabetic drug 6.
• Have a body mass index (BMI) of 25-45 kg/m² 6.
• Have an estimated glomerular filtration rate (eGFR) of 45 ml/s or higher 3.