Tradjenta (Linagliptin) Does Not Require Titration
Tradjenta (linagliptin) is administered as a fixed dose of 5 mg once daily with no titration required. 1
Dosing Regimen
- Standard dose: 5 mg once daily, taken at any time of day, with or without food 1, 2
- No dose adjustment needed for any patient population, including:
Key Distinguishing Feature
Linagliptin is unique among DPP-4 inhibitors because it requires no dose adjustment based on kidney function. 3 This contrasts sharply with other DPP-4 inhibitors:
- Sitagliptin: Requires reduction to 50 mg daily with eGFR 30-50 mL/min/1.73 m² and 25 mg daily with eGFR <30 mL/min/1.73 m² 3
- Saxagliptin: Maximum 2.5 mg daily when eGFR ≤45 mL/min/1.73 m² 3
- Alogliptin: Requires reduction to 12.5 mg daily with eGFR 30-60 mL/min/1.73 m² and 6.25 mg daily with eGFR <30 mL/min/1.73 m² 3
Pharmacokinetic Rationale
The lack of titration requirement stems from linagliptin's unique elimination pathway—it is eliminated primarily via biliary excretion (approximately 95%) with minimal renal clearance (only ~5% excreted in urine). 4, 5 This nonrenal route of elimination allows consistent drug exposure across all levels of kidney function. 2, 6
Fixed-Dose Combination Option
When combined with metformin as a fixed-dose combination (Jentadueto), linagliptin is dosed as 2.5 mg twice daily (combined with metformin doses). 2, 7 This twice-daily regimen of 2.5 mg has been shown to be non-inferior to 5 mg once daily for HbA1c reduction. 7
Common Pitfall to Avoid
Do not reduce the linagliptin dose in patients with renal impairment—this is a common error based on experience with other DPP-4 inhibitors. 3 The 5 mg once-daily dose should be maintained regardless of eGFR level, even in patients on dialysis. 1, 6