Can Tradjenta (linagliptin) be taken with Jardiance (empagliflozin)?

Tradjenta (Linagliptin) Can Be Safely Taken with Jardiance (Empagliflozin)

Yes, Tradjenta (linagliptin) can be safely taken with Jardiance (empagliflozin), and this combination may provide complementary benefits for glycemic control in patients with type 2 diabetes. 1

Evidence Supporting Combination Therapy

• The 2019 ESC Guidelines specifically state that GLP-1 receptor agonists and DPP-4 inhibitors (including linagliptin) have a neutral effect on risk of heart failure and may be considered in patients with diabetes 2
• Similarly, SGLT2 inhibitors (including empagliflozin) are recommended to lower risk of heart failure hospitalization and reduce progression of diabetic kidney disease 2
• Clinical trials have demonstrated that the combination of empagliflozin and linagliptin is well-tolerated with a safety profile similar to the individual monotherapies 1

Mechanism of Action and Benefits

• Linagliptin (Tradjenta) is a DPP-4 inhibitor that works by improving pancreatic islet function, augmenting glucose-dependent insulin secretion and decreasing elevated plasma glucagon levels 3
• Empagliflozin (Jardiance) is an SGLT2 inhibitor that improves glycemic control by causing glucosuria and ameliorating glucotoxicity 3
• The combination provides complementary mechanisms of action, targeting different pathophysiologic abnormalities in type 2 diabetes 3, 4

Safety Considerations

• Pooled analysis of five randomized controlled trials showed that the incidence of adverse events with the empagliflozin/linagliptin combination was similar to that with either medication alone 1
• Hypoglycemia risk is low (<2% of patients) and similar across treatment groups (combination vs. monotherapy) 1
• Genital infections occurred more frequently with empagliflozin-containing regimens compared to linagliptin alone, consistent with the known side effect profile of SGLT2 inhibitors 1

Clinical Efficacy

• The combination of linagliptin and empagliflozin has been shown to produce clinical improvements in glycemic control that are generally superior to improvements seen with either medication alone 4
• At HbA1c values below 8.5%, the combination produces an additive effect on glycemic control 3
• A fixed-dose combination tablet containing both medications is available, which can reduce pill burden and potentially improve medication adherence 4

Special Populations

• Linagliptin is the first DPP-4 inhibitor to be eliminated primarily via a non-renal route, enabling its use without dosage adjustment in patients with any degree of renal impairment 5, 6
• Empagliflozin has demonstrated cardiovascular benefits in patients with type 2 diabetes and established cardiovascular disease 2

Precautions

• Saxagliptin (a different DPP-4 inhibitor) is not recommended in patients with type 2 diabetes and high risk of heart failure, but this warning does not apply to linagliptin 2
• SGLT2 inhibitors should be used with caution in patients at risk for diabetic ketoacidosis, acute kidney injury, or dehydration 2
• Consider temporarily discontinuing empagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis 2