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# Tradjenta (linagliptin)
## Overview
Linagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used to improve glycemic control in adults with type 2 diabetes mellitus. It increases incretin levels, which enhances insulin secretion and decreases glucagon secretion in a glucose-dependent manner.
## Primary Indications
* Improve glycemic control in adults with type 2 diabetes mellitus, as an adjunct to diet and exercise.
* May be used as monotherapy or in combination with other antidiabetic agents, including metformin, sulfonylureas, thiazolidinediones, SGLT2 inhibitors, and insulin.
## Adult Dosing
* The recommended dose is **5 mg orally once daily**.
* There are no established dose adjustments based on renal function.
## Pediatric Dosing
* The safety and efficacy of linagliptin in pediatric patients have not been established.
## Dose Adjustments
* No dose adjustment is required based on renal impairment or hepatic impairment.
## Contraindications
* Hypersensitivity to linagliptin or any excipients in the formulation.
## Adverse Effects
* **Common:** Nasopharyngitis, diarrhea, cough, upper respiratory tract infection.
* **Serious:** Hypoglycemia (especially when used with sulfonylureas or insulin), hypersensitivity reactions (including anaphylaxis, angioedema, urticaria, rash), severe and debilitating arthralgia, bullous pemphigoid.
## Key Drug Interactions
* **CYP3A4 Inducers (e.g., rifampin):** May decrease linagliptin exposure and efficacy. Coadministration is not recommended.
* **Sulfonylureas and Insulin:** Increased risk of hypoglycemia. Monitor blood glucose and consider a lower dose of the sulfonylurea or insulin.
## Monitoring
* Monitor blood glucose levels to assess efficacy and check for hypoglycemia, especially when coadministered with medications that can cause hypoglycemia.
* Monitor for signs and symptoms of hypersensitivity reactions and severe arthralgia.
## Clinical Pearls
* Linagliptin is primarily eliminated unchanged by the liver and is not renally excreted, making it a favorable option for patients with renal impairment, as dose adjustment is not necessary.
* Due to the risk of severe arthralgia, advise patients to report any joint pain, and consider discontinuing linagliptin if it occurs.
* Be vigilant for signs of bullous pemphigoid, a rare but serious skin reaction.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information for complete details and to verify dosage and safety recommendations before use.*
