Combination Pills Similar to Glyxambi (Empagliflozin/Linagliptin)
The most similar combination pill to Glyxambi is Qtern (saxagliptin/dapagliflozin), which also combines a DPP-4 inhibitor with an SGLT2 inhibitor for type 2 diabetes management. 1
Understanding Glyxambi
Glyxambi is a fixed-dose combination tablet that contains:
- Empagliflozin (SGLT2 inhibitor): 10mg or 25mg
- Linagliptin (DPP-4 inhibitor): 5mg
This combination provides complementary mechanisms of action 2:
- Empagliflozin removes glucose through the urine by blocking glucose reabsorption in the kidneys
- Linagliptin increases hormones that stimulate insulin production and decreases glucagon levels
Similar Combination Pills
1. Qtern (Saxagliptin/Dapagliflozin)
- Mechanism: Combines a DPP-4 inhibitor (saxagliptin) with an SGLT2 inhibitor (dapagliflozin)
- Indication: Improvement of glycemic control in adults with T2DM
- Benefits: Similar to Glyxambi, provides dual mechanism of action with decreased body weight and low risk of hypoglycemia 1
Key Differences Between the Combinations
Both combinations work through similar mechanisms, but there are important differences to consider:
SGLT2 Inhibitor Component
Empagliflozin (in Glyxambi):
Dapagliflozin (in Qtern):
DPP-4 Inhibitor Component
Linagliptin (in Glyxambi):
Saxagliptin (in Qtern):
Clinical Considerations for Selection
Cardiovascular Disease
- For patients with established cardiovascular disease or at high risk, Glyxambi may be preferred due to empagliflozin's proven cardiovascular mortality benefits 3
- Saxagliptin (in Qtern) is not recommended for patients with heart failure or at risk of heart failure 4
Renal Function
- Linagliptin (in Glyxambi) requires no dose adjustment in renal impairment 4
- Both SGLT2 inhibitors have reduced efficacy with declining renal function and should be avoided in severe renal impairment (eGFR <30 mL/min/1.73m²) 3
Weight Management
Blood Pressure
- Both combinations can modestly reduce blood pressure 2
Practical Prescribing Algorithm
For patients with established cardiovascular disease or heart failure:
- Prefer Glyxambi (empagliflozin/linagliptin) due to empagliflozin's proven cardiovascular benefits and linagliptin's neutral effect on heart failure
For patients with renal impairment:
- For moderate renal impairment: Glyxambi may be preferred as linagliptin requires no dose adjustment
- For severe renal impairment (eGFR <30 mL/min/1.73m²): Neither combination is recommended
For patients with A1C <8.5%:
- Either combination may be effective, as linagliptin/empagliflozin produces an additive effect at this A1C range 5
For patients with A1C >8.5%:
- Consider that linagliptin/empagliflozin combination shows less than additive reduction compared to individual components at higher A1C levels 5
Common Pitfalls and Caveats
- Heart Failure Risk: Avoid Qtern (contains saxagliptin) in patients with heart failure or at high risk for heart failure 4
- Renal Function: Monitor renal function before and during treatment with either combination
- Genital Infections: Both combinations may increase risk of genital mycotic infections due to the SGLT2 inhibitor component 4
- Ketoacidosis Risk: Both SGLT2 inhibitors carry a rare risk of euglycemic diabetic ketoacidosis 4
- Additive Effect: At A1C values above 8.5%, the combination of linagliptin and empagliflozin may provide less than additive reduction compared to each agent alone 5