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- Clinician Information:
Jentadueto Side Effects Center
Medical Editor: Charles Patrick Davis, MD, PhD
Jenadueto (linagliptin and metformin hydrochloride) is a combination of two drugs indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both linagliptin and metformin is appropriate. Jenadueto is not available as a generic drug. Common side effects of Jentadueto are pancreatitis, nasopharyngitis, diarrhea, and hypoglycemia.
Jenadueto is available in the following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg metformin twice daily. Jenadueto should be taken daily with meals, with gradual dose escalation to reduce the gastrointestinal side effects due to metformin. Cationic drugs eliminated by renal tubular secretion may reduce metformin elimination. Serious side effects include lactic acidosis, hypoglycemia and impaired hepatic function. Women should alert their doctors if they are pregnant or planning to become pregnant. It is not known if Jentadueto will harm an unborn baby. Pregnant women should talk with their doctors about the best way to control blood sugar while pregnant. Women should also talk with their doctors if they are breastfeeding or plan to breastfeed. It is not known if Jentadueto passes into breast milk. Breastfeeding women should talk with their doctors about the best way to feed their babies while taking Jenadueto. Safety and effectiveness has not been established in the pediatric population.
Our Jenadueto Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Jentadueto FDA Prescribing Information: Side Effects
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety of concomitantly administered linagliptin (daily dose 5 mg) and metformin (mean daily dose of approximately 1800 mg) has been evaluated in 2816 patients with type 2 diabetes mellitus treated for ≥ 12 weeks in clinical trials.
Three placebo-controlled studies with linagliptin + metformin were conducted: 2 studies were 24 weeks in duration, 1 study was 12 weeks in duration. In the 3 placebo-controlled clinical studies, adverse events which occurred in ≥ 5% of patients receiving linagliptin + metformin (n=875) and were more common than in patients given placebo + metformin (n=539) included nasopharyngitis (5.7% vs 4.3%).
In a 24-week factorial design study, adverse events reported in ≥ 5% of patients receiving linagliptin + metformin and were more common than in patients given placebo are shown in Table 1.
Table 1 : Adverse Reactions Reported in ≥ 5%
of Patients Treated with Linagliptin + Metformin and Greater than with Placebo
in a 24-week Factorial-Design Study
|Combination of Linagliptin with Metformin
|n (%)||n (%)||n (%)||n (%)|
|Nasopharyngitis||1 (1.4)||8 (5.6)||8 (2.7)||18 (6.3)|
|Diarrhea||2 (2.8)||5 (3.5)||11 (3.8)||18 (6.3)|
Other adverse reactions reported in clinical studies with treatment of linagliptin + metformin were hypersensitivity (e.g., urticaria, angioedema, or bronchial hyperreactivity), cough, decreased appetite, nausea, vomiting, pruritus, and pancreatitis.
Adverse reactions reported in ≥ 2% of patients treated with linagliptin 5 mg and more commonly than in patients treated with placebo included: nasopharyngitis (7.0% vs 6.1%), diarrhea (3.3% vs 3.0%), and cough (2.1% vs 1.4%).
Rates for other adverse reactions for linagliptin 5 mg vs placebo when linagliptin was used in combination with specific anti-diabetic agents were: urinary tract infection (3.1% vs 0%) and hypertriglyceridemia (2.4% vs 0%) when linagliptin was used as add-on to sulfonylurea; hyperlipidemia (2.7% vs 0.8%) and weight increased (2.3% vs 0.8%) when linagliptin was used as add-on to pioglitazone; and constipation (2.1% vs 1%) when linagliptin was used as add-on to basal insulin therapy.
Other adverse reactions reported in clinical studies with treatment of linagliptin monotherapy were hypersensitivity (e.g., urticaria, angioedema, localized skin exfoliation, or bronchial hyperreactivity) and myalgia. In the clinical trial program, pancreatitis was reported in 15.2 cases per 10,000 patient year exposure while being treated with linagliptin compared with 3.7 cases per 10,000 patient year exposure while being treated with comparator (placebo and active comparator, sulfonylurea). Three additional cases of pancreatitis were reported following the last administered dose of linagliptin.
Long-term treatment with metformin has been associated with a decrease in vitamin B12 absorption which may very rarely result in clinically significant vitamin B12 deficiency (e.g., megaloblastic anemia) [see WARNINGS AND PRECAUTIONS].
In a 24-week factorial design study, hypoglycemia was reported in 4 (1.4%) of 286 subjects treated with linagliptin + metformin, 6 (2.1%) of 291 subjects treated with metformin, and 1 (1.4%) of 72 subjects treated with placebo. When linagliptin was administered in combination with metformin and a sulfonylurea, 181 (22.9%) of 792 patients reported hypoglycemia compared with 39 (14.8%) of 263 patients administered placebo in combination with metformin and sulfonylurea. Adverse reactions of hypoglycemia were based on all reports of hypoglycemia. A concurrent glucose measurement was not required or was normal in some patients. Therefore, it is not possible to conclusively determine that all these reports reflect true hypoglycemia.
In the study of patients receiving linagliptin as add-on therapy to a stable dose of insulin for up to 52 weeks (n=1261), no significant difference in the incidence of investigator reported hypoglycemia, defined as all symptomatic or asymptomatic episodes with a self measured blood glucose ≤ 70 mg/dL, was noted between the linagliptin-(31.4%) and placebo-(32.9%) treated groups.
Use in Renal Impairment
Linagliptin was compared to placebo as add-on to pre-existing antidiabetic therapy over 52 weeks in 133 patients with severe renal impairment (estimated GFR < 30 mL/min). For the initial 12 weeks of the study, background antidiabetic therapy was kept stable and included insulin, sulfonylurea, glinides, and pioglitazone. For the remainder of the trial, dose adjustments in antidiabetic background therapy were allowed.
In general, the incidence of adverse events including severe hypoglycemia was similar to those reported in other linagliptin trials. The observed incidence of hypoglycemia was higher (linagliptin, 63% compared to placebo, 49%) due to an increase in asymptomatic hypoglycemic events especially during the first 12 weeks when background glycemic therapies were kept stable. Ten linagliptin-treated patients (15%) and 11 placebo-treated patients (17%) reported at least one episode of confirmed symptomatic hypoglycemia (accompanying finger stick glucose ≤ 54 mg/dL). During the same time period, severe hypoglycemic events, defined as an event requiring the assistance of another person to actively administer carbohydrate, glucagon or other resuscitative actions, were reported in 3 (4.4%) linagliptin-treated patients and 3 (4.6%) placebo-treated patients. Events that were considered life-threatening or required hospitalization were reported in 2 (2.9%) patients on linagliptin and 1 (1.5%) patient on placebo.
Renal function as measured by mean eGFR and creatinine clearance did not change over 52 weeks' treatment compared to placebo.
Changes in laboratory findings were similar in patients treated with linagliptin + metformin compared to patients treated with placebo + metformin. Changes in laboratory values that occurred more frequently in the linagliptin + metformin group and ≥ 1% more than in the placebo group were not detected.
No clinically meaningful changes in vital signs were observed in patients treated with linagliptin.
Additional adverse reactions have been identified during postapproval use of linagliptin. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- Acute pancreatitis, including fatal pancreatitis [see INDICATIONS AND USAGE and WARNINGS AND PRECAUTIONS]
- Hypersensitivity reactions including anaphylaxis, angioedema, and exfoliative skin conditions [see WARNINGS AND PRECAUTIONS]
Read the entire FDA prescribing information for Jentadueto (Linagliptin and Metformin Hydrochloride) »
Additional Jenadueto Information
- Jenadueto Drug Interactions Center: linagliptin-metformin oral
- Jenadueto Side Effects Center
- Jenadueto FDA Approved Prescribing Information including Dosage
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