Linagliptin (Tradjenta) Dosing for Type 2 Diabetes
The recommended dosage of Tradjenta (linagliptin) is 5 mg orally once daily, with no dose adjustment required for any degree of renal impairment. 1
Standard Dosing
- Tradjenta 5 mg tablet taken once daily
- Can be taken with or without food 1
- No titration required - starts and maintains at 5 mg daily
- No dose adjustment needed for:
- Renal impairment (any level of kidney function)
- Hepatic impairment
- Elderly patients
- Based on race, body weight, sex, or age 2
Special Considerations
Renal Function
- Unlike other DPP-4 inhibitors, linagliptin is primarily eliminated via a non-renal route 2, 3
- Approximately 5% of the dose is excreted in urine 2
- No dosage adjustment is required for patients with any degree of renal impairment 3
- This unique characteristic makes linagliptin particularly valuable for patients with kidney disease
Alternative Dosing Option
- In patients taking metformin twice daily, linagliptin can alternatively be administered as 2.5 mg twice daily 4
- This twice-daily regimen has shown non-inferior efficacy to the standard 5 mg once-daily dosing 4
- May be useful when considering fixed-dose combination products with metformin
Drug Interactions
- Strong P-glycoprotein/CYP3A4 inducers (e.g., rifampin) may reduce linagliptin efficacy 1
- No clinically relevant interactions with other commonly prescribed medications for diabetes patients, including warfarin and digoxin 2
Administration Considerations
- Long terminal half-life (>100 hours) but accumulation half-life is shorter (~10 hours) 2
- Steady-state plasma concentrations are reached within 4 days of daily administration 2
- Oral bioavailability is approximately 30% 2
Safety Profile
- Most common adverse reaction (≥5% incidence) is nasopharyngitis 1
- Low risk of hypoglycemia when used as monotherapy
- Increased hypoglycemia risk when combined with insulin secretagogues or insulin
- No effect on body weight 3
Important Warnings
- Discontinue if pancreatitis is suspected 1
- Hypersensitivity reactions including anaphylaxis, angioedema, and exfoliative skin conditions have been reported 1
- Severe and disabling arthralgia has been reported 1
- Reports of bullous pemphigoid requiring hospitalization 1
Tradjenta's unique pharmacokinetic profile with minimal renal clearance makes it particularly valuable for patients with renal impairment who would otherwise require dose adjustments with other antidiabetic medications.