Empagliflozin + Linagliptin interactions

Food & lifestyle

• alcohol

  Moderate

  Others

  Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

  What to do: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

  10 sources

  1. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
  5. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals (2002):
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72

  Show all 10 sourcesShow fewer sources

  9. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

• alcohol

  Moderate

  Others

  Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia.

  What to do: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

  10 sources

  1. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
  5. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals (2002):
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72

  Show all 10 sourcesShow fewer sources

  9. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Conditions

Conditions in which Empagliflozin + Linagliptin needs care, as documented in this source.

• Kidney Diseases

  Major

  The glucose lowering effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors is decreased in patients with worsening renal function. Additionally, patients with renal impairment function (eGFR less than 60 mL/min/1.73 m2) the elderly, and patients on loop diuretics may be more likely to experience adverse reactions related to volume depletion such as hypotension and acute kidney injury during therapy. Renal function should be evaluated prior to treatment initiation and monitored regularly in at-risk patients. Assess volume status and correct volume depletion before initiating therapy. The use of SGLT-2 inhibitors in patients undergoing dialysis is contraindicated. In both patients with and without type 2 diabetes, beneficial effects in chronic kidney disease and heart failure have been observed with SGLT2 inhibitor therapy. The manufacturer's product labeling should be consulted for indication specific renal dosing for SGLT2 inhibitors.

  4 sources

  1. "Product Information. Invokana (canagliflozin)." Janssen Pharmaceuticals (2013):
  2. "Product Information. Farxiga (dapagliflozin)." Bristol-Myers Squibb (2014):
  3. "Product Information. Jardiance (empagliflozin)." Boehringer Ingelheim (2014):
  4. "Product Information. Steglatro (ertugliflozin)." Merck & Co., Inc (2017):

• Pancreatitis

  Major

  There have been postmarketing reports of acute pancreatitis in patients taking DPP-4 inhibitors. These drugs should be used with caution in patients with a history of pancreatitis or pancreatic disease, although it is unknown if they are at increased risk. Patients should be observed for signs and symptoms of pancreatitis during treatment. If pancreatitis is suspected, treatment should be discontinued immediately and appropriate management should be initiated.

  4 sources

  1. "Product Information. Januvia (sitagliptin)." Merck & Co., Inc (2006):
  2. "Product Information. Onglyza (saxagliptin)." Bristol-Myers Squibb (2009):
  3. "Product Information. Tradjenta (linagliptin)." Boehringer Ingelheim (2011):
  4. "Product Information. Nesina (alogliptin)." Takeda Pharmaceuticals America (2013):

• Hypotension

  Moderate

  Sodium-glucose cotransporter 2 (SGLT-2) inhibitors cause intravascular volume contraction which may lead to symptomatic hypotension after treatment initiation especially in the elderly, in patients with impaired renal function, patients with low systolic blood pressure, or those using diuretics . Volume status should be assessed and corrected before starting treatment and patients should be monitored during therapy.

  4 sources

  1. "Product Information. Invokana (canagliflozin)." Janssen Pharmaceuticals (2013):
  2. "Product Information. Farxiga (dapagliflozin)." Bristol-Myers Squibb (2014):
  3. "Product Information. Jardiance (empagliflozin)." Boehringer Ingelheim (2014):
  4. "Product Information. Steglatro (ertugliflozin)." Merck & Co., Inc (2017):

• Infections

  Moderate

  An increase in the risk of genital mycotic infections has been reported with the use of a sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Care should be exercised when using this agent in patients who have a history of genital mycotic infections or who are uncircumcised as these patients are more likely to develop genital mycotic infections. Monitor and treat appropriately.

  1 source

  1. "Product Information. Steglatro (ertugliflozin)." Merck & Co., Inc (2017):

Therapeutic duplication

Drug classes that overlap with Empagliflozin + Linagliptin, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• incretin-based therapies

  The recommended maximum number of medicines in the 'incretin-based therapies' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'incretin-based therapies' category.

  Example product in the source data (US market): Insulin degludec/liraglutide

• incretin-based therapies

  The recommended maximum number of medicines in the 'incretin-based therapies' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'incretin-based therapies' category.

  Example product in the source data (US market): Soliqua