What is the recommended dosing for Linagliptin (Trajenta) in patients with Impaired renal function?

From the Guidelines

Linagliptin is typically dosed at 5 mg once daily for adults with type 2 diabetes, regardless of meals, and requires no adjustment for patients with kidney or liver impairment, as stated in the most recent guidelines 1. This standard dose makes it unique among DPP-4 inhibitors. The medication works by inhibiting the DPP-4 enzyme, which increases incretin hormone levels, stimulating insulin release and reducing glucagon secretion when blood glucose is elevated. Linagliptin can be used as monotherapy or in combination with other antidiabetic medications like metformin, sulfonylureas, or insulin. Some key points to consider when prescribing linagliptin include:

• Common side effects include nasopharyngitis, hypoglycemia (when used with insulin or sulfonylureas), and rarely hypersensitivity reactions.
• Patients should be monitored for pancreatitis, though this is uncommon, as noted in previous studies 1.
• The medication should be taken at the same time each day to maintain consistent blood levels, and patients should continue their recommended diet and exercise program while using this medication.
• According to recent guidelines, linagliptin has a neutral effect on weight and minimal risk of hypoglycemia when used as monotherapy 1.
• It's also important to note that linagliptin has been shown to be safe in terms of cardiovascular outcomes, as demonstrated in cardiovascular outcome trials (CVOTs) 1.

From the FDA Drug Label

The dosing information for linagliptin is not explicitly stated in the provided text, but it can be inferred from the context that the standard dose is 5 mg once daily.

• Dosing: The text mentions that "Each film-coated tablet of TRADJENTA contains 5 mg of linagliptin free base" and that "No dosage adjustment is recommended for patients with renal impairment" or hepatic impairment.
• Administration: The text states that "TRADJENTA may be administered with or without food".
• Special populations: The text provides information on the use of linagliptin in specific populations, including patients with renal or hepatic impairment, but does not provide explicit dosing recommendations for these populations. The FDA drug label does provide some information about the dosing of linagliptin, but it is not a direct answer to the question. Based on the information provided, the dose of linagliptin is 5 mg once daily, and no dose adjustment is needed for patients with renal or hepatic impairment 2.

From the Research

Linagliptin Dosing

• The recommended dose of linagliptin is 5 mg once daily, as stated in studies 3, 4, 5, 6, 7.
• Linagliptin can be used alone or in combination with other antidiabetic agents, including metformin, a sulfonylurea, thiazolidinedione, or insulin 3, 5, 6.
• A fixed-dose combination of linagliptin/metformin (Jentadueto) is also available, with a recommended dose of 2.5 mg linagliptin twice daily 3, 5.
• Linagliptin does not require dosage adjustment in patients with renal impairment, as it is eliminated primarily via a nonrenal route 3, 4, 5, 6, 7.
• The efficacy and safety of linagliptin have been demonstrated in patients with type 2 diabetes, including those with renal impairment, and it is generally well tolerated with a low risk of hypoglycemia and no effect on body weight 3, 4, 5, 6, 7.