TRADJENTA Dose Adjustment
TRADJENTA (linagliptin) is administered at a fixed dose of 5 mg once daily and does not require dose titration or adjustment, regardless of glycemic control, renal function, or hepatic function. 1, 2
Standard Dosing
- The approved dose is 5 mg once daily, taken with or without food 1, 2
- No dose escalation is recommended or approved—the 5 mg dose is both the starting and maintenance dose 1, 2
- When combined with metformin in a fixed-dose combination (Jentadueto), linagliptin is administered as 2.5 mg twice daily, which has been shown to be non-inferior to 5 mg once daily 3
No Adjustment Required for Special Populations
Renal Impairment
- No dosage adjustment is needed for any degree of renal impairment, including severe impairment or end-stage renal disease 1, 2
- Linagliptin is the first DPP-4 inhibitor eliminated predominantly via a nonrenal route, making it unique among its class 1, 2
Hepatic Impairment
- No dosage adjustment required for hepatic dysfunction 4
Elderly Patients
- No dosage adjustment needed for patients ≥70 years of age 2
If Glycemic Control Is Inadequate
When TRADJENTA 5 mg daily fails to achieve glycemic targets, the solution is NOT to increase the TRADJENTA dose—instead, add or intensify other glucose-lowering agents:
First-Line Combination Strategy
- Continue metformin at maximum tolerated dose (up to 2000-2500 mg daily) if not already optimized 5
- Add an SGLT2 inhibitor with proven cardiovascular or kidney benefit if eGFR ≥20 mL/min/1.73 m² 5
Second-Line Options
- Add a GLP-1 receptor agonist with proven cardiovascular benefit if not meeting individualized glycemic targets 5
- Consider basal insulin if HbA1c remains >7% despite optimal oral therapy, starting at 10 units once daily or 0.1-0.2 units/kg/day 6
Critical Pitfall to Avoid
Do not attempt to "increase" TRADJENTA beyond 5 mg once daily—this is not an approved or effective strategy. The medication works through DPP-4 inhibition, which is maximally achieved at the 5 mg dose. 1, 2
Drug Interactions Affecting Efficacy
- Concurrent use of strong CYP3A4 or P-glycoprotein inducers (e.g., rifampin) may limit linagliptin efficacy 4
- Consider alternative antibiotics or adjust diabetes regimen if rifampin is required 4