Lijenta-M 500 Tablet

Combination of a DPP-4 inhibitor and a biguanide for type 2 diabetes in adults, with diet and exercise, when either medicine alone is not enough, or to replace separate tablets.

Adults: one tablet (2.5 mg/500 mg, 2.5 mg/850 mg or 2.5 mg/1,000 mg) twice daily with meals; dose chosen according to the current metformin dose.

Maximum: linagliptin 5 mg + metformin 2,000 mg per day.

• Extended-release forms (5/1,000 mg) are taken once daily.
• Start metformin low and increase gradually to reduce stomach upset.
• Not for children under 18.

• Type 1 diabetes, diabetic ketoacidosis
• Kidney impairment with eGFR below 30 ml/min
• Conditions causing low oxygen or acidosis: severe infection, dehydration, shock, recent heart attack, severe heart or lung failure
• Liver failure, heavy alcohol use
• Before iodinated contrast X-ray studies or major surgery (stop temporarily)
• Allergy to linagliptin or metformin

Common: nausea, diarrhoea, stomach pain, loss of appetite, metallic taste, cough, nasopharyngitis.

Less common: low blood sugar (mainly with sulphonylureas or insulin), itching.

Rare but serious: lactic acidosis (vomiting, muscle pain, fast breathing, drowsiness — emergency), pancreatitis (severe stomach pain), bullous pemphigoid (blisters), angioedema, vitamin B12 deficiency with long-term use.

• Check kidney function at least yearly (more often in elderly).
• Stop and seek help with severe persistent abdominal pain (pancreatitis).
• Hold during dehydrating illness (vomiting/diarrhoea).
• Check vitamin B12 with long-term use.

Insulin is preferred in pregnancy. Not recommended while breastfeeding.

• Contrast media containing iodine (stop before and 48 hours after)
• Alcohol (lactic acidosis)
• Sulphonylureas, insulin (low blood sugar — lower their doses)
• Rifampicin (reduces linagliptin effect)
• Diuretics, NSAIDs, ACE inhibitors (kidney effects); steroids (raise sugar)

Lactic acidosis is the main danger with metformin overdose — emergency treatment; haemodialysis may be needed.

Store below 30°C, dry.