Ilinpru (Linagliptin)

Linagliptin is a DPP-4 inhibitor used in the management of type 2 diabetes mellitus.

• Type 2 diabetes mellitus: improves glycemic control when combined with diet, exercise and other antidiabetic agents.
• Adults with renal impairment: offers effective glucose lowering without the need for dose adjustment.
• Patients inadequately controlled on metformin: serves as an add‑on therapy to achieve target HbA1c.
• Elderly patients: provides effective glycaemic control with a low risk of hypoglycaemia.
• Combination therapy with insulin: can be added to basal insulin regimens to further lower HbA1c.

• Linagliptin selectively inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which degrades the incretin hormones GLP-1 and GIP. By blocking DPP-4, linagliptin increases endogenous levels of these incretins, enhancing glucose-dependent insulin secretion and suppressing glucagon release after meals, thereby lowering post-prandial and overall blood glucose concentrations.

Linagliptin may be associated with several adverse reactions, which are categorized by frequency.

Common Side Effects

• Upper respiratory tract infection: mild symptoms such as nasal congestion or sore throat.
• Headache: transient mild to moderate headache.
• Nasopharyngitis: inflammation of the nasal passages and throat.
• Diarrhoea: mild, self‑limiting episodes of loose stools.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain indicating possible pancreatic inflammation.
• Severe hypersensitivity reactions: rash, angioedema or anaphylaxis.
• Hepatic enzyme elevation: notable increase in liver transaminases.
• Severe allergic reaction: Stevens‑Johnson syndrome presenting with skin detachment.

When prescribing linagliptin, several precautions should be considered to ensure safe use.

• Renal function: monitor renal status, although dose adjustment is not required, use caution in severe impairment.
• Hepatic impairment: assess liver function before initiation and periodically during therapy.
• Pancreatitis history: avoid use in patients with a prior history of pancreatitis.
• Concomitant hypoglycaemic agents: adjust doses of sulfonylureas or insulin to reduce risk of hypoglycaemia.
• Cardiovascular disease: monitor for any worsening of heart failure symptoms.
• Store at ambient temperature: keep tablets in the original container, protect from moisture and light.

Linagliptin can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors: may increase linagliptin exposure; avoid co‑administration.
• Strong CYP3A4 inducers: may reduce linagliptin levels, compromising glucose control.

Moderate Interactions (Monitor Closely)

• Insulin or sulfonylureas: increased risk of hypoglycaemia; monitor blood glucose.
• Diuretics: may affect renal handling; observe renal function.
• Rifampicin: may lower linagliptin concentrations; consider alternative therapy.