Jentadueto (Linagliptin and Metformin)

Metformin and Linagliptin are frequently used as medications for controlling high blood sugar as elements of the treatment plan along with consistent diet and exercise. In the medicine named Jentadueto, there are both medications. However, they do not work in a similar way, and special knowledge is needed to take them.

What Is Jentadueto?

What is Jentadueto used for, and how exactly does it work?

Jentadueto is approved by the Food and Drug Administration (FDA) as a proper treatment for adults with type 2 diabetes as an adjunctive therapy. It consists of Metformin and Linagliptin - oral diabetes medicines performing insulin production and regulating insulin level functions.

Prescription

Jentadueto is a combination tablet containing the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin and the biguanide metformin. It is a prescription drug in the form of an oral tablet existing under the brand names Jentadueto and Jentadueto XR.

To categorize the medicine, Jentadueto drug class is a combination of hypoglycemic DPP-4 inhibitor (MoA, or Mechanism of Action) and biguanide.

Mechanism Of Action

Now, to the Metformin and Linagliptin MoA. Linagliptin acts mainly by increasing the incretin levels: incretins are natural substances essential to control blood sugar and increase insulin release, which is especially vital after a meal. The same bodies make the liver produce less sugar. So, the mechanism of Linagliptin action is simply restoring the body's natural response to the insulin it makes so that it gets closer to normal.

Metformin, in turn, works by lowering the production of glucose in the liver and absorption of glucose by the intestines, which impacts the food breaking down process. In terms of the Jentadueto generic line, there is currently no generic version of this drug.

How Is Jentadueto Medication Supplied

The Jentadueto medication comes in the form of film-coated tablets (extended release tablets). Pack sizes vary from 10x1, 14x1, 28x1, 30x1, 56x1, 60x1, 84x1, 90x1, 100x1 and 120x1 in tablets per pack. Multipacks, such as double packs, each containing 60x1, 90x2, or 100x2, are available too.

Tablets are stored in aluminum lidding foil in perforated blisters. Other packs come in high-density polyethylene bottles with plastic screwing caps. They contain 14, 60, or 180 film-coated tablets.

Jentadueto is marketed in two strengths:

1. 2.5 mg linagliptin plus 850 mg metformin hydrochloride. These tablets are white and oval-shaped, printed on one side with the Boehringer Ingelheim logo and D5 on the top line and 1000M on the bottom line.
2. 2.5 mg linagliptin plus 1000 mg metformin hydrochloride. These are yellow and oval-shaped, with the same Boehringer Ingelheim logo, D2 on the top line and 1000M on the bottom line.

Administration route: oral.

The medication must be kept out of reach of children. One should keep the drug under room temperature, - 25°C (77°F), protected from exposure to light and moisture.

Linagliptin Metformin Warnings And Precautions

Before starting a course of Jentadueto, one should inform a doctor about every other health condition and medication taken. This can have an immense impact on whether they will be allowed to take Linagliptin Metformin pills.

So, here are the main warnings and reasons the Jentadueto medication use might be prohibited. Make sure to tell your doctor or pharmacist if you've ever had one of these:

1. Severe kidney diseases.
2. Diabetic ketoacidosis.
3. Allergy to Metformin, Linagliptin, or any other component of Jentadueto.
4. Serious breathing problems (asthma, obstructive lung disease).
5. Heart disease.
6. Pancreatitis.
7. Bullous Pemphigoid.
8. Hypoglycemia.
9. Liver diseases (Hepatitis A, B, C, immune system abnormalities, liver cancers, and other conditions such as chronic alcohol abuse, nonalcoholic fatty liver disease, etc.) and taking medications to treat them.
10. Stones in gallbladder.
11. Blood issues (high triglycerides, anemia, vitamin B12 deficiency).
12. Having type 1 diabetes.
13. Having a severe infection, such as infection of the bronchial system.

Conditions and circumstances that are less dangerous but may be enough to doubt Jentadueto usage include:

1. Consuming herbal products.
2. Taking any prescription or non-prescription drugs, especially anti-diabetic medicines or insulin.
3. Having undergone surgery or planning on one.
4. Planning to get an injection of contrast agent or dye prior to an X-ray procedure.

The latter 2 points, as a rule, are addressed with a temporary stop in taking the medication. Next, consider some of the most hazardous no-go conditions from the list above.

Lactic Acidosis

Lactic acidosis might lead to coma and occurs when lactic acid production exceeds lactic acid clearance. In medical terms, it is often linked to impaired tissue oxygenation (abnormalities in oxygen delivery) or damage to mitochondrial oxygen utilization.

If a patient has lactic acidosis, they cannot start the medication. Yet, some patients are prone to developing this condition while being on Metformin and Linagliptin, so it also belongs to Jentadueto side effects.

Hence, immediately contact a doctor for further instructions or visit the nearest hospital in case any of these signs appear:

• reduced heartbeat and body temperature;
• diarrhea;
• metallic taste in the mouth;
• vomiting;
• nausea;
• muscle cramps;
• upset stomach;
• cough;
• breathing problems;
• constant tiredness.

Beware that mild signs of lactic acidosis may worsen over time so do not neglect any of these symptoms to prevent the fatal condition.

Pancreatitis

It is required to stop using Metformin if a person experiences any of pancreatitis symptoms:

1. Severe pain in the upper stomach spreading to the back.
2. Vomiting and nausea.
3. Rapid heartbeat.
4. Loss of appetite.

Hypoglycemia

Hypoglycemia is a low blood glucose which shows itself in:

• sudden sweating and nervousness;
• shaking;
• hunger;
• seizures;
• rapid heartbeat;
• loss of consciousness;
• dizziness;
• blurred vision.

Under doctor's supervision, the frequency of mealtimes might be increased in case of hypoglycemia. As a rule, doctors establish a meal schedule for such patients with regard to their individual needs.

Hypersensitivity Reactions

Reactions of hypersensitivity include:

• burning eyes;
• fever;
• itching and skin rash;
• sore throat;
• hives;
• difficult breathing;
• swelling in the throat or face.

Vitamin B12 Deficiency

In case you already have a low level of vitamin B12, taking Jentadueto over time may cause a more severe deficiency. So, make sure to track your blood parameters since this deficiency is tricky and doesn't show itself in any symptoms.

In rare cases that it occurs, it leads to anemia or particular neurologic manifestations. The condition is corrected by quitting Metformin or Vitamin B12 supplement consumption.

Severe And Disabling Arthralgia

It is a fact approved by FDA that DPP-4 inhibitors may result in severe joint pain, or arthralgia. In case patients start to feel consistent and persistent pain in their joints, they are recommended to quit and contact healthcare providers right away.

Bullous Pemphigoid

Bullous Pemphigoid is a way some patients' immune systems (with malfunctions) may react to medications and is one of Jentadueto side effects. Prescription drugs such as penicillin, furosemide, sulfasalazine, and etanercept can trigger this condition.

The signs are:

• large blisters;
• itchy skin weeks or months before blisters appear;
• eczema and hive-like rashes.

The excess of ultraviolet light and radiation, as well as diabetes, psoriasis, and multiple sclerosis are contributing factors.

Heart Failure

Another serious condition belonging to the cases when Metformin and Linagliptin are not prescribed and at the same time to Jentadueto side effects is heart failure. It is revealed in the following symptoms:

• chest pain and tightness;
• dilated neck veins;
• irregular and trouble breathing;
• swelling in the face, hands, feet, and legs;
• lower urine output;
• extreme fatigue.

That is why it is vital to discuss every single detail of your medical history and lifestyle with a nurse, doctor or pharmacist. That can save your life or let you avoid conditions which are hard to treat.

What To Avoid During The Treatment

Every time a doctor prescribes patients this medication, there is a set of requirements for them to follow to prevent unwanted side effects and stay on the safe side.

1. Alcohol.

Drinking beverages with alcohol strengthens the effect of Metformin and increases the risks of lactic acidosis. This can also result in extremely low blood glucose. Especially avoid drinking alcohol on an empty stomach or after physical exercises. All in all, patients are advised to discuss this matter with their healthcare teams.

2. Being caught off guard in emergency cases.

With type 2 diabetes, there might be times when those undergoing treatment will need emergency help because of the disease. So, being prepared is the key. Wearing a medical identification (ID) bracelet or carrying one around is a good idea, as well as a list of all medications you are taking.

3. Taking other medications.

Do not take any other drugs unless it has been discussed with your doctor. Non prescription medicines and food supplements, despite sounding innocent, can also cause harm in patients with type 2 diabetes. Make sure to ask for a doctor's permission for pills such as aspirin and even medications to treat cough, fever, asthma, or appetite control.

4. Lack of counseling.

It's necessary to inform close people and immediate family about the algorithm of actions when a Jentadueto dosage needs to be changed or a side effect prevented. A special consultation is needed to understand what should and shouldn't be done in case any side effects appear.

Jentadueto Dosing and Directions

Each Jentadueto tablet may contain different amounts of active substances:

1. 2,5 mg of Linagliptin and 500 mg of Metformin.
2. 2,5 mg of Linagliptin and 850 mg of Metformin.
3. 2,5 mg of Linagliptin and 1000 mg of Metformin (for extended release).
4. 5 mg of Linagliptin and 1000 mg of Metformin (for extended release).

The tablets are meant to treat type 2 diabetes mellitus.

In all treatment cases, the Jentadueto dose should be individualized. The tolerability and effectiveness are a basis for identifying a dose by a doctor, whereas the maximum dosage of 2.5 mg Linagliptin/1000 mg Metformin hydrochloride (HCl) twice a day must not be exceeded.

The pills are directed to be taken with meals. Dose escalation needs careful supervision and has to be gradual in order to avoid possible gastrointestinal (GI) side effects.

For a starting dose, these doses are recommended:

• In patients not treated with Metformin hydrochloride (HCl), the initial dose is 2.5 mg Linagliptin/1000 mg Metformin HCl twice a day.
• In patients treated with Metformin HCl already, a measure of 2.5 mg Linagliptin is prescribed and the relevant dose of Metformin remains, taken twice a day with meals.
• In patients already treated with both Metformin HCl and Linagliptin, doses need to be counted individually, with the purpose of switching to Jentadueto in the same doses as previously.

Renal Impairment

To prescribe a correct Jentadueto dose, doctors need to assess renal function first. This lets them come up with the estimated glomerular filtration rate (eGFR) in patients with renal impairment. The procedure needs to be done regularly after as well.

There is a clear contraindication of Jentadueto in patients with a measured glomerular filtration rate below 30 mL/min/1.73 m2. Starting treatment with Metformin in people with an eGFR between 30-45 mL/min/1.73 m2 is not recommended either.

When the rate falls lower than 45 mL/min/1.73 m2, risks and benefits are evaluated to see if the therapy can bring any improvement for the current condition.

Important: if a patient's eGFR drops below 30 mL/min/1.73 m2, stop the medication use.

Iodinated Contrast Imaging Procedures

Either prior to or during the procedure of iodinated contrast imaging, taking the medication needs a stop. This concerns patients with:

• the eGFR from 30 till 60 mL/min/1.73 m2;
• heart failure;
• liver diseases or alcoholism in the medical history;
• intra-arterial iodinated contrast planned.

How often does the eGFR need to be re-evaluated during such procedures? The standard time is 48 hours after imaging. Diabetes treatment with Jentadueto can be restarted once renal function gets stable.

What Happens If I Miss A Dose?

A missed dose of Jentadueto doesn't mean the routine is screwed up. The key is just to take the next dose as soon as you remember to. Skip the missed dose and move on according to the schedule.

What you should not do under any conditions is take an extra dose trying to make up for the one you missed.

What Happens If I Overdose?

Side effects of the drug overdose vary from patient to patient and hence, need to be treated situationally, with regard to particular symptoms. However, there are established directions for handling overdosing relying on how much the norm of Linagliptin or Metformin was exceeded.

Clinically the overdose of Linagliptin up to 600 mg, which is an extreme one making nearly 120 times the daily dose, didn't cause any adverse reactions in healthy people. Still, if we look at the same kinds of experiments with Metformin, we will see that they resulted in severe hypoglycemia in nearly 10% of cases. Moreover, lactic acidosis in one third of the studied overdose cases.

Signs of overdose may include:

• stomach pain;
• lowering of blood pressure;
• drowsiness;
• slow heartbeat;
• respiratory distress;
• myalgias;
• general malaise.

In most serious cases of overdose, Metformin can be cleared out from the body with hemodialysis. In most scary cases, when a patient collapses or can't breathe, don't hesitate and call 911.

Jentadueto Side Effects

Along with more rare side effects, patients should be informed about the most common Jentadueto side effects. Still, the observed effects do not always correspond to the ones seen in practice.

Clinical trials and experiments have proven 3 most frequent side effects of the medication:

1. Diarrhea.

When the dose includes the combination of Metformin and Linagliptin, nearly 3.3% of patients developed diarrhea more commonly than the group receiving placebo.

2. Nasopharyngitis.

This is the inflammation of nasal cavities and pharynx that was observed in nearly 7% of the studied group taking Linagliptin.

3. Cough.

This side effect was seen in 2.1% of patients.

All the studies included the Jentadueto dosage Linagliptin 5 mg and 1000 mg Metformin. Other effects can sometimes include gas, weight loss, headache, and common colds.

Linagliptin Metformin Usage In Specific Populations

Special considerations need to be made for special kinds of patients. Consulting a doctor is needed previously.

Pregnancy

There is limited data on the effects of Jentadueto on pregnant women. In animal reproduction studies, no harmful developmental effects were seen.

However, the background risk of major birth defects is present and is 6-10% in patients with HbA1c>7. The risk grows till 20-25% in patients with HbA1c>10. This only concerns women with pre-gestational diabetes.

The risk of miscarriage is still unknown. These 2 types of risks in clinically recognized pregnancies in the US are 2 to 4% and 15 to 20% accordingly. The benefits of controlling diabetes during pregnancy may often outshine the possible risks for women and embryos, so the medication is prescribed only after individual consultation.

Lactation

It wasn't studied if Metformin and Linagliptin enter human milk. With regard to other drugs being able to penetrate into a woman's milk and cause adverse reactions in infants, patients face the choice: either to stop breastfeeding or quit the medication. This must be discussed with the doctor.

Geriatric Use

No studies have been made on Jentadueto and Jentadueto XR use in geriatric patients. Age is generally not considered a significant factor, however some data of 2022 shows that the overall plasma clearance of Metformin decreases with age. Moreover, half-life is prolonged and the Cmax grows. So, the use of Metformin in senior patients is linked to changes in renal function, regardless of the particular brand name.

Jentadueto Medication Interactions With Other Drugs

Now, the medication is a combination of two active ingredients: Metformin and Linagliptin. Both substances are likely to interact with other meds. In the image below, you can see safe combinations with these 2 actives.

Metformin

Here are the drug interactions with Metformin.

Linagliptin

The studied drug interactions with Linagliptin include:

Jentadueto Price

Now, Jentadueto price depends on the country, manufacturer and the retailer which you get the medication from.

The price without health insurance will be nearly $500 per 60 tablets. If you've got medical insurance, the cost will range from $10 to $60 per pack, with one capsule with Jentadueto dosing 2.5 mg Linagliptin/1000 mg Metformin hydrochloride (HCl) being worth $0.94 on average.

Since this is a prescription drug in the United States of America, in most cases you are going to get it for a dropped price.

Jentadueto Alternative Solutions

For cases like the hazard-causing interactions with other drugs, Jentadueto alternative medications were developed. If additional medications are impossible to replace, there are other DPP-4 inhibitors:

• Januvia (Sitagliptin)

This is another oral drug that keeps blood sugar levels stable by blocking the enzyme DPP-4 which leads to the release of insulin for a longer time. This lowers blood sugar.

Januvia is taken regardless of the meal time. Mind that it becomes less effective if taken simultaneously with birth control pills whereas taken with insulin might lead to hypoglycemia.

• Onglyza (Saxagliptin)

This drug may be taken at any time of the day and is made to enhance the body's natural ability to control blood glucose.

• Nesina (Alogliptin)

Nesina tablets contain the active ingredient alogliptin and can substitute Jentadueto in terms of managing blood sugar. In addition, no important drug-drug interactions were observed so far so it is easier to combine with other medications.

These are the most common Jentadueto alternative drugs. Yet, remember not to take more than one DPP-4 inhibitor at a time.