In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Help your patients navigate
the Road Ahead

INDICATION AND IMPORTANT LIMITATIONS OF USE FOR JENTADUETO AND JENTADUETO XR

JENTADUETO and JENTADUETO XR tablets are 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.

JENTADUETO and JENTADUETO XR should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

JENTADUETO and JENTADUETO XR have not been studied in patients with a history of pancreatitis, and it is unknown if using JENTADUETO or JENTADUETO XR increases the risk of developing pancreatitis in these patients.

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Efficacy

Initial Combination Therapy with Linagliptin + Metformin

STATISTICALLY SIGNIFICANT A1C REDUCTIONS IN A FIXED-DOSE COMBINATION

Placebo-adjusted mean difference in A1C at 24 weeks in patients receiving linagliptin and metformin, alone or in combination (%)1-3*†‡§

Chart: Placebo-adjusted mean difference in A1C at 24 weeksStudy Designs

The safety and efficacy of JENTADUETO and JENTADUETO XR have been established based on adequate and well-controlled studies of linagliptin and metformin coadministered in patients with type 2 diabetes mellitus inadequately controlled on diet and exercise and in combination with sulfonylurea.

In patients receiving CO-ADMINISTERED LINAGLIPTIN 2.5 mg/metformin 1000 mg twice daily as initial therapy:1-3*

Secondary endpoint: Percent of patients who achieved A1C <7%1,2#

Percent of patients who achieved A1C <7%Study Designs

Study in patients with high baseline A1C

A1C REDUCTION WITH LINAGLIPTIN + METFORMIN VS LINAGLIPTIN ALONE

Primary Endpoint: Adjusted mean difference in A1C from baseline at 24 weeks in treatment-naïve patients with high baseline A1C (≥8.5% to ≤12.0%)1,2

Chart: Adjusted mean difference in A1C from baseline at 24 weeks
Study Designs

A1C reductions over time in treatment-naïve patients with a high baseline A1C

Secondary endpoint: Adjusted mean change in A1C from baseline (≥8.5% to ≤12.0%) over 24 weeks in an FAS completers' analysis3‡

Chart: Adjusted mean change in A1C from baseline over 24 weeksStudy Designs

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Efficacy

STATISTICALLY SIGNIFICANT A1C REDUCTIONS IN A FIXED-DOSE COMBINATION

Placebo-adjusted mean difference in A1C at 24 weeks in patients receiving linagliptin and metformin, alone or in combination (%)1-3*†‡§

Chart: Placebo-adjusted mean difference in A1C at 24 weeksStudy Designs

The safety and efficacy of JENTADUETO and JENTADUETO XR have been established based on adequate and well-controlled studies of linagliptin and metformin coadministered in patients with type 2 diabetes mellitus inadequately controlled on diet and exercise and in combination with sulfonylurea.

In patients receiving CO-ADMINISTERED LINAGLIPTIN 2.5 mg/metformin 1000 mg twice daily as initial therapy:1-3*

Secondary endpoint: Percent of patients who achieved A1C <7%1,2#

Percent of patients who achieved A1C <7%Study Designs

A1C REDUCTION WITH LINAGLIPTIN + METFORMIN VS LINAGLIPTIN ALONE

Primary Endpoint: Adjusted mean difference in A1C from baseline at 24 weeks in treatment-naïve patients with high baseline A1C (≥8.5% to ≤12.0%)1,2

Chart: Adjusted mean difference in A1C from baseline at 24 weeks
Study Designs

A1C reductions over time in treatment-naïve patients with a high baseline A1C

Secondary endpoint: Adjusted mean change in A1C from baseline (≥8.5% to ≤12.0%) over 24 weeks in an FAS completers' analysis3‡

Chart: Adjusted mean change in A1C from baseline over 24 weeksStudy Designs

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Dosing

A fixed dose with flexibility

Once- and twice-daily dosing options that allow you to adjust metformin dosage while keeping linagliptin at 5 mg per day.

jentadueto

Available in 3 dosage strengths. Taken twice daily.

2.5 mg linagliptin / 500 mg metformin HCI

2.5 mg linagliptin/500 mg metformin HCI

2.5 mg linagliptin / 850 mg metformin HCI

2.5 mg linagliptin/850 mg metformin HCI

2.5 mg linagliptin / 1000 mg metformin HCI

2.5 mg linagliptin/1000 mg metformin HCI

TABLETS SHOWN ARE NOT ACTUAL SIZE

The dosage of JENTADUETO should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended dose of 2.5 mg linagliptin/1000 mg metformin hydrochloride twice daily.

JENTADUETO should be given twice daily with meals with gradual dose escalation to reduce the gastrointestinal side effects to metformin.

RECOMMENDED STARTING DOSE

  • In patients not currently treated with metformin, initiate JENTADUETO treatment with 2.5 mg linagliptin/500 mg metformin hydrochloride twice daily.
  • In patients already treated with metformin, start with 2.5 mg linagliptin and the current dose of metformin taken at each of the two daily meals (e.g., a patient on metformin 1000 mg twice daily would be started on 2.5 mg linagliptin/1000 mg metformin hydrochloride twice daily with meals).
  • Patients already treated with linagliptin and metformin individual components may be switched to JENTADUETO containing the same doses of each component.

No studies have been performed specifically examining the safety and efficacy of JENTADUETO in patients previously treated with other oral antihyperglycemic agents and switched to JENTADUETO. Any change in therapy should be undertaken with care and appropriate monitoring as changes in glycemic control can occur.

INSULIN SECRETAGOGUES OR INSULIN

Coadministration of JENTADUETO with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Monitoring of Renal Function

  • Before initiation of therapy with JENTADUETO and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal impairment is anticipated (e.g., elderly), renal function should be assessed more frequently and JENTADUETO discontinued if evidence of renal impairment is present.
  • Radiological studies and surgical procedures: JENTADUETO should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure necessitating restricted intake of food or fluids, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been confirmed to be normal.
Reference:
1. JENTADUETO Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc. 2015.

jentadueto XR

Available in 2 dosage strengths. Taken once daily.

2.5 mg linagliptin / 1000 mg metformin HCI

2.5 mg linagliptin/
1000 mg metformin HCI

JENTADUETO XR 2.5 mg/1000 mg should be taken as two tablets together once daily.

5 mg linagliptin/1000 mg metformin HCI

5 mg linagliptin/
1000 mg metformin HCI

JENTADUETO XR 5 mg/1000 mg should be taken as a single tablet once daily.

JENTADUETO XR 2.5 mg/1000 mg should be taken as two tablets together once daily. JENTADUETO XR 5 mg/1000 mg should be taken as a single tablet once daily.

TABLETS SHOWN ARE NOT ACTUAL SIZE

The dosage of JENTADUETO XR should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended total daily dose of linagliptin 5 mg and metformin hydrochloride 2000 mg.

JENTADUETO XR should be given once daily with a meal.

RECOMMENDED STARTING DOSE

  • In patients currently not treated with metformin, initiate JENTADUETO XR treatment with 5 mg linagliptin/1000 mg metformin hydrochloride extended-release once daily with a meal.
  • In patients already treated with metformin, start JENTADUETO XR with 5 mg of linagliptin total daily dose and a similar total daily dose of metformin once daily with a meal.
  • In patients already treated with linagliptin and metformin or JENTADUETO, switch to JENTADUETO XR containing 5 mg of linagliptin total daily dose and a similar total daily dose of metformin once daily with a meal.

JENTADUETO XR should be swallowed whole. The tablets must not be split, crushed, dissolved, or chewed before swallowing. There have been reports of incompletely dissolved tablets being eliminated in the feces for other tablets containing metformin extended-release. If a patient reports seeing tablets in feces, the healthcare provider should assess adequacy of glycemic control.

No studies have been performed specifically examining the safety and efficacy of JENTADUETO XR in patients previously treated with other oral antihyperglycemic agents and switched to JENTADUETO XR. Any change in therapy should be undertaken with care and appropriate monitoring as changes in glycemic control can occur.

RECOMMENDED DOSING IN RENAL IMPAIRMENT

Assess renal function prior to initiation of JENTADUETO XR and periodically thereafter.

JENTADUETO XR is contraindicated in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2.

Initiation of JENTADUETO XR in patients with an eGFR between 30-45 mL/min/1.73 m2 is not recommended.

In patients taking JENTADUETO XR whose eGFR later falls below 45 mL/min/1.73 m2, assess benefit risk of continuing therapy.

Discontinue JENTADUETO XR if the patient’s eGFR later falls below 30 mL/min/1.73 m2.

DISCONTINUATION FOR IODINATED CONTRAST IMAGING PROCEDURES

Discontinue JENTADUETO XR before or at the time of an iodinated contrast imaging procedure in patients: with an eGFR between 30 and 60 mL/min/1.73 m2; with a history of liver disease, alcoholism or heart failure; or who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart JENTADUETO XR if renal function is stable.

INSULIN SECRETAGOGUES OR INSULIN

Coadministration of JENTADUETO XR with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Reference:
1. JENTADUETO XR Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc. 2016.

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Dosing

A fixed dose with flexibility
Once- and twice-daily dosing options that allow you to adjust metformin dosage while keeping linagliptin at 5 mg per day.

Available in 3 dosage strengths. Taken twice daily.

2.5 mg linagliptin / 500 mg metformin HCI

2.5 mg linagliptin/500 mg metformin HCI

2.5 mg linagliptin / 850 mg metformin HCI

2.5 mg linagliptin/850 mg metformin HCI

2.5 mg linagliptin / 1000 mg metformin HCI

2.5 mg linagliptin/1000 mg metformin HCI

TABLETS SHOWN ARE NOT ACTUAL SIZE

The dosage of JENTADUETO should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended dose of 2.5 mg linagliptin/1000 mg metformin hydrochloride twice daily.

JENTADUETO should be given twice daily with meals with gradual dose escalation to reduce the gastrointestinal side effects to metformin.

RECOMMENDED STARTING DOSE

  • In patients not currently treated with metformin, initiate JENTADUETO treatment with 2.5 mg linagliptin/500 mg metformin hydrochloride twice daily.
  • In patients already treated with metformin, start with 2.5 mg linagliptin and the current dose of metformin taken at each of the two daily meals (e.g., a patient on metformin 1000 mg twice daily would be started on 2.5 mg linagliptin/1000 mg metformin hydrochloride twice daily with meals).
  • Patients already treated with linagliptin and metformin individual components may be switched to JENTADUETO containing the same doses of each component.

No studies have been performed specifically examining the safety and efficacy of JENTADUETO in patients previously treated with other oral antihyperglycemic agents and switched to JENTADUETO. Any change in therapy should be undertaken with care and appropriate monitoring as changes in glycemic control can occur.

INSULIN SECRETAGOGUES OR INSULIN

Coadministration of JENTADUETO with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Monitoring of Renal Function

  • Before initiation of therapy with JENTADUETO and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal impairment is anticipated (e.g., elderly), renal function should be assessed more frequently and JENTADUETO discontinued if evidence of renal impairment is present.
  • Radiological studies and surgical procedures: JENTADUETO should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure necessitating restricted intake of food or fluids, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been confirmed to be normal.
Reference:
1. JENTADUETO Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc. 2015.

Available in 2 dosage strengths. Taken once daily.

2.5 mg linagliptin / 1000 mg metformin HCI

2.5 mg linagliptin/
1000 mg metformin HCI

JENTADUETO XR 2.5 mg/1000 mg should be taken as two tablets together once daily.

5 mg linagliptin/1000 mg metformin HCI

5 mg linagliptin/
1000 mg metformin HCI

JENTADUETO XR 5 mg/1000 mg should be taken as a single tablet once daily.

JENTADUETO XR 2.5 mg/1000 mg should be taken as two tablets together once daily. JENTADUETO XR 5 mg/1000 mg should be taken as a single tablet once daily.

TABLETS SHOWN ARE NOT ACTUAL SIZE

The dosage of JENTADUETO XR should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended total daily dose of linagliptin 5 mg and metformin hydrochloride 2000 mg.

JENTADUETO XR should be given once daily with a meal.

RECOMMENDED STARTING DOSE

  • In patients currently not treated with metformin, initiate JENTADUETO XR treatment with 5 mg linagliptin/1000 mg metformin hydrochloride extended-release once daily with a meal.
  • In patients already treated with metformin, start JENTADUETO XR with 5 mg of linagliptin total daily dose and a similar total daily dose of metformin once daily with a meal.
  • In patients already treated with linagliptin and metformin or JENTADUETO, switch to JENTADUETO XR containing 5 mg of linagliptin total daily dose and a similar total daily dose of metformin once daily with a meal.

JENTADUETO XR should be swallowed whole. The tablets must not be split, crushed, dissolved, or chewed before swallowing. There have been reports of incompletely dissolved tablets being eliminated in the feces for other tablets containing metformin extended-release. If a patient reports seeing tablets in feces, the healthcare provider should assess adequacy of glycemic control.

No studies have been performed specifically examining the safety and efficacy of JENTADUETO XR in patients previously treated with other oral antihyperglycemic agents and switched to JENTADUETO XR. Any change in therapy should be undertaken with care and appropriate monitoring as changes in glycemic control can occur.

RECOMMENDED DOSING IN RENAL IMPAIRMENT

Assess renal function prior to initiation of JENTADUETO XR and periodically thereafter.

JENTADUETO XR is contraindicated in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2.

Initiation of JENTADUETO XR in patients with an eGFR between 30-45 mL/min/1.73 m2 is not recommended.

In patients taking JENTADUETO XR whose eGFR later falls below 45 mL/min/1.73 m2, assess benefit risk of continuing therapy.

Discontinue JENTADUETO XR if the patient’s eGFR later falls below 30 mL/min/1.73 m2.

DISCONTINUATION FOR IODINATED CONTRAST IMAGING PROCEDURES

Discontinue JENTADUETO XR before or at the time of an iodinated contrast imaging procedure in patients: with an eGFR between 30 and 60 mL/min/1.73 m2; with a history of liver disease, alcoholism or heart failure; or who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart JENTADUETO XR if renal function is stable.

INSULIN SECRETAGOGUES OR INSULIN

Coadministration of JENTADUETO XR with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Reference:
1. JENTADUETO XR Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc. 2016.

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Adverse Reactions

The safety of concomitantly administered linagliptin and metformin has been evaluated in
more than 2800 patients with type 2 diabetes mellitus treated for >12 weeks in clinical trials1,2

Table: Adverse Reactions
Table: Adverse Reactions
  • 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.
  • LINAGLIPTIN

  • 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.
  • Adverse reactions reported in ≥2% of patients treated with linagliptin 5 mg and more commonly than in patients with placebo included: nasopharyngitis (7.0% vs 6.1%), diarrhea (3.3% vs 3.0%), and cough (2.1% vs 1.4%).
  • In the clinical trial program, pancreatitis was reported in 15.2 cases per 10,000 patient-years of exposure while being treated with linagliptin compared with 3.7 cases per 10,000 patient-years of 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.
  • Metformin

  • The most common adverse reactions due to initiation of metformin are diarrhea, nausea/vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache.
  • 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).
  • Hypoglycemia

  • 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.
  • In the study of patients receiving linagliptin as add-on therapy to a stable dose of insulin for up to 52 weeks, no significant difference in the incidence of investigator-reported hypoglycemia was noted compared with placebo (31.4% vs 32.9%, respectively).
  • In a study of linagliptin compared with placebo as add-on to pre-existing antidiabetic therapy in patients with severe renal impairment, the incidence of hypoglycemia was higher in patients treated with linagliptin (63%) vs in patients treated with placebo (49%). Severe hypoglycemic events were reported in 4.4% of patients treated with linagliptin vs 4.6% of patients treated with placebo in this trial.
  • Laboratory tests

  • Changes in laboratory findings were similar in patients treated with linagliptin/metformin compared to patients treated with placebo plus 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.

 

In addition to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes

Resources

To help with the road ahead

Important Safety Information, Indication and Important Limitations of Use Important Safety Information, Indication
and Important Limitations of Use
+
  • jentadueto
  • jentadueto XR

Warning: Risk of Lactic Acidosis

Lactic acidosis is a rare, but serious, complication that can occur due to metformin accumulation. The risk increases with conditions such as renal impairment, sepsis, dehydration, excess alcohol intake, hepatic impairment, and acute congestive heart failure.

The onset is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress.

Laboratory abnormalities include low pH, increased anion gap, and elevated blood lactate.

If acidosis is suspected, JENTADUETO should be discontinued and the patient hospitalized immediately.

Contraindications

JENTADUETO is contraindicated in patients with:

  • Renal impairment (e.g., serum creatinine ≥1.5 mg/dL for men or ≥1.4 mg/dL for women, or abnormal creatinine clearance).
  • Acute or chronic metabolic acidosis, including diabetic ketoacidosis.
  • A history of hypersensitivity reaction to linagliptin, such as anaphylaxis, angioedema, exfoliative skin conditions, urticaria, or bronchial hyperreactivity.
  • Hypersensitivity to metformin.

WARNINGS AND PRECAUTIONS

Lactic Acidosis
  • Lactic acidosis is a serious, metabolic complication that can occur due to metformin accumulation during treatment with JENTADUETO and is fatal in approximately 50% of cases.
  • The reported incidence of lactic acidosis in patients receiving metformin is approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-years. Reported cases have occurred primarily in diabetic patients with significant renal impairment, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications.
  • Patients with congestive heart failure requiring pharmacologic management, particularly when accompanied by hypoperfusion and hypoxemia due to unstable or acute failure, are at increased risk of lactic acidosis.
  • The risk of lactic acidosis increases with the degree of renal impairment and the patient's age. The risk of lactic acidosis may be significantly decreased by regular monitoring of renal function in patients taking metformin. Treatment of the elderly should be accompanied by careful monitoring of renal function. Metformin treatment should not be initiated in any patients unless measurement of creatinine clearance demonstrates that renal function is not reduced.
  • Metformin should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis.
Pancreatitis

There have been postmarketing reports of acute pancreatitis, including fatal pancreatitis, in patients taking linagliptin. Take careful notice of potential signs and symptoms of pancreatitis. If pancreatitis is suspected, promptly discontinue JENTADUETO and initiate appropriate management. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using JENTADUETO.

Monitoring of Renal Function

Before initiation of therapy with JENTADUETO and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal impairment is anticipated (e.g., elderly), renal function should be assessed more frequently and JENTADUETO discontinued if evidence of renal impairment is present.

Radiological studies and surgical procedures: JENTADUETO should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure necessitating restricted intake of food or fluids, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been confirmed to be normal.

Impaired Hepatic Function

Impaired hepatic function has been associated with cases of lactic acidosis with metformin therapy. JENTADUETO tablets should generally be avoided in patients with clinical or laboratory evidence of hepatic impairment.

Use with Medications Known to Cause Hypoglycemia

Insulin secretagogues and insulin are known to cause hypoglycemia. The use of linagliptin in combination with an insulin secretagogue (e.g., sulfonylurea) was associated with a higher rate of hypoglycemia compared with placebo in a clinical trial. A lower dose of the insulin secretagogue or insulin may be required to reduce the risk of hypoglycemia when used in combination with JENTADUETO.

Hypersensitivity Reactions

There have been postmarketing reports of serious hypersensitivity reactions in patients treated with linagliptin (one of the components of JENTADUETO). These reactions include anaphylaxis, angioedema, and exfoliative skin conditions. Onset of these reactions occurred within the first 3 months after initiation of treatment with linagliptin, with some reports occurring after the first dose. If a serious hypersensitivity reaction is suspected, discontinue JENTADUETO, assess for other potential causes for the event, and institute alternative treatment for diabetes.

Angioedema has also been reported with other dipeptidyl peptidase-4 (DPP-4) inhibitors. Use caution in a patient with a history of angioedema to another DPP-4 inhibitor because it is unknown whether such patients will be predisposed to angioedema with JENTADUETO.

Vitamin B12 Levels

Vitamin B12 deficiency: Metformin may lower Vitamin B12 levels. Monitor hematologic parameters annually.

Alcohol Intake

Alcohol is known to potentiate the effect of metformin on lactate metabolism. Patients should be warned against excessive alcohol intake while receiving JENTADUETO.

Hypoxic States

Cardiovascular collapse (shock) from whatever cause (e.g., acute congestive heart failure, acute myocardial infarction, and other conditions characterized by hypoxemia) has been associated with lactic acidosis and may also cause prerenal azotemia. When such events occur in patients on JENTADUETO therapy, the drug should be promptly discontinued.

Severe and Disabling Arthralgia

Severe and disabling arthralgia has been reported in patients taking DPP-4 inhibitors. Consider as a possible cause for severe joint pain and discontinue drug if appropriate.

Macrovascular Outcomes

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with JENTADUETO or any other antidiabetic drug.

ADVERSE REACTIONS

  • In a 24-week factorial design study, adverse reactions reported in ≥5% of patients treated with JENTADUETO and more commonly than in patients treated with placebo were nasopharyngitis and diarrhea.
  • 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. In the placebo-controlled studies, hypoglycemia was more commonly reported in patients treated with the combination of linagliptin and metformin with SU (22.9%) compared with those treated with the combination of placebo and metformin with SU (14.8%).
  • In the clinical trial program, pancreatitis was reported in 15.2 cases per 10,000 patient-years exposure while being treated with linagliptin compared with 3.7 cases per 10,000 patient-years 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.

DRUG INTERACTIONS

  • Because cationic drugs eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems, careful patient monitoring and dose adjustment of JENTADUETO and/or the interfering drug is recommended in patients who are taking cationic medications that are excreted via the proximal renal tubular secretory system.
  • The efficacy of JENTADUETO may be reduced when administered in combination with a strong P-glycoprotein inducer or CYP3A4 inducer (e.g., rifampin). Use of alternative treatments is strongly recommended.
  • The concomitant use of carbonic anhydrase inhibitors (e.g., topiramate) and metformin may induce metabolic acidosis. Use these drugs with caution in patients treated with JENTADUETO, as the risk of lactic acidosis may increase.

USE IN SPECIFIC POPULATIONS

  • As there are no adequate and well-controlled studies in pregnant women, the safety of JENTADUETO in pregnant women is not known. JENTADUETO should be used during pregnancy only if clearly needed.
  • It is not known whether linagliptin is excreted in human milk. Metformin is excreted in human milk in low concentrations. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
  • The safety and effectiveness of JENTADUETO in patients below the age of 18 have not been established.
  • JENTADUETO should be used with caution as age increases, as aging can be associated with reduced renal function.

INDICATION AND IMPORTANT LIMITATIONS OF USE

JENTADUETO tablets are 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.

JENTADUETO should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

JENTADUETO has not been studied in patients with a history of pancreatitis, and it is unknown if using JENTADUETO increases the risk of developing pancreatitis in these patients.

JD PROF ISI 31AUG2015

Please see Prescribing Information for JENTADUETO, including Boxed Warning regarding risk of lactic acidosis and Medication Guide.

Warning: Risk of Lactic Acidosis

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors include renal impairment, concomitant use of certain drugs, age > 65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information.

If lactic acidosis is suspected, discontinue JENTADUETO XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.

Contraindications

JENTADUETO XR is contraindicated in patients with:

  • Severe renal impairment (eGFR below 30 mL/min/1.73 m2).
  • Acute or chronic metabolic acidosis, including diabetic ketoacidosis.
  • A history of hypersensitivity reaction to linagliptin, such as anaphylaxis, angioedema, exfoliative skin conditions, urticaria, or bronchial hyperreactivity.
  • Hypersensitivity to metformin.

WARNINGS AND PRECAUTIONS

Lactic Acidosis

There have been postmarketing cases of metformin-associated lactic acidosis, including fatal cases. These cases had a subtle onset and were accompanied by nonspecific symptoms such as malaise, myalgias, abdominal pain, respiratory distress, or increased somnolence; however, hypothermia, hypotension and resistant bradyarrhythmias have occurred with severe acidosis. Metformin-associated lactic acidosis was characterized by elevated blood lactate concentrations (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), and an increased lactate pyruvate ratio; metformin plasma levels generally >5 mcg/mL.

If lactic acidosis is suspected, discontinue JENTADUETO XR and institute general supportive measures promptly in a hospital setting. Prompt hemodialysis is recommended to correct the acidosis.

Educate patients and their families about the symptoms of lactic acidosis and if these symptoms occur instruct them to discontinue JENTADUETO XR and promptly notify their healthcare provider.

Risk factors for lactic acidosis and recommendations to reduce the risk:

  • Renal Impairment: Postmarketing metformin-associated lactic acidosis cases primarily occurred in patients with significant renal impairment. Evaluate renal function prior to initiating and annually or more frequent monitoring in patients at increased risk of developing renal impairment.
  • Drug Interactions: Consider more frequent monitoring when JENTADUETO XR is administered with drugs that impair renal function, result in hemodynamic change, interfere with acid-base balance, or increase metformin accumulation.
  • Age 65 or Greater: Assess renal function more frequently in elderly patients.
  • Radiological Studies with Contrast: Stop JENTADUETO XR at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of hepatic impairment, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure, and restart JENTADUETO XR if renal function is stable.
  • Surgery and Other Procedures: Discontinue JENTADUETO XR while patients have restricted food and fluid intake during surgical or other procedures.
  • Hypoxic States: Discontinue JENTADUETO XR in conditions associated with hypoxemia.
  • Excessive Alcohol Intake: Warn patients against excessive alcohol intake.
  • Hepatic Impairment: Avoid use of JENTADUETO XR in patients with hepatic disease
Pancreatitis

There have been postmarketing reports of acute pancreatitis, including fatal pancreatitis, in patients taking linagliptin. Take careful notice of potential signs and symptoms of pancreatitis. If pancreatitis is suspected, promptly discontinue JENTADUETO XR and initiate appropriate management. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using JENTADUETO XR.

Use with Medications Known to Cause Hypoglycemia

Insulin secretagogues and insulin are known to cause hypoglycemia. The use of linagliptin in combination with an insulin secretagogue (e.g., sulfonylurea) was associated with a higher rate of hypoglycemia compared with placebo in a clinical trial. A lower dose of the insulin secretagogue or insulin may be required to reduce the risk of hypoglycemia when used in combination with JENTADUETO XR.

Hypersensitivity Reactions

There have been postmarketing reports of serious hypersensitivity reactions in patients treated with linagliptin (one of the components of JENTADUETO XR). These reactions include anaphylaxis, angioedema, and exfoliative skin conditions. Onset of these reactions occurred within the first 3 months after initiation of treatment with linagliptin, with some reports occurring after the first dose. If a serious hypersensitivity reaction is suspected, discontinue JENTADUETO XR, assess for other potential causes for the event, and institute alternative treatment for diabetes.

Angioedema has also been reported with other dipeptidyl peptidase-4 (DPP-4) inhibitors. Use caution in a patient with a history of angioedema to another DPP-4 inhibitor because it is unknown whether such patients will be predisposed to angioedema with JENTADUETO XR.

Vitamin B12 Levels

Vitamin B12 deficiency: Metformin may lower Vitamin B12 levels. Monitor hematologic parameters annually.

Severe and Disabling Arthralgia

Severe and disabling arthralgia has been reported in patients taking DPP-4 inhibitors. Consider as a possible cause for severe joint pain and discontinue drug if appropriate.

Macrovascular Outcomes

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with JENTADUETO XR or any other antidiabetic drug.

ADVERSE REACTIONS

  • In a 24-week factorial design study, adverse reactions reported in ≥5% of patients treated with linagliptin and metformin and more commonly than in patients treated with placebo were nasopharyngitis and diarrhea.
  • 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. In the placebo-controlled studies, hypoglycemia was more commonly reported in patients treated with the combination of linagliptin and metformin with SU (22.9%) compared with those treated with the combination of placebo and metformin with SU (14.8%).
  • In the clinical trial program, pancreatitis was reported in 15.2 cases per 10,000 patient-years exposure while being treated with linagliptin compared with 3.7 cases per 10,000 patient-years 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.

DRUG INTERACTIONS

  • The concomitant use of carbonic anhydrase inhibitors (e.g., topiramate) and metformin may induce metabolic acidosis. Use these drugs with caution and consider more frequent monitoring in patients treated with JENTADUETO XR, as the risk of lactic acidosis may increase.
  • Because cationic drugs eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems, careful patient monitoring and dose adjustment of JENTADUETO XR and/or the interfering drug is recommended in patients who are taking cationic medications that are excreted via the proximal renal tubular secretory system.
  • The efficacy of JENTADUETO XR may be reduced when administered in combination with a strong P-glycoprotein inducer or CYP3A4 inducer (e.g., rifampin). Use of alternative treatments is strongly recommended.

USE IN SPECIFIC POPULATIONS

  • There are no adequate and well-controlled studies of JENTADUETO XR in pregnant women. JENTADUETO XR should be used during pregnancy only if clearly needed.
  • It is not known whether linagliptin is excreted in human milk. Metformin is excreted in human milk in low concentrations. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
  • Discuss the potential for unintended pregnancy with premenopausal women as therapy with metformin may result in ovulation in some anovulatory women.
  • The safety and effectiveness of JENTADUETO XR in patients under the age of 18 has not been established.
  • JENTADUETO XR should be used with caution as age increases, as aging can be associated with reduced renal function.

INDICATION AND IMPORTANT LIMITATIONS OF USE

JENTADUETO XR is 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.

JENTADUETO XR should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

JENTADUETO XR has not been studied in patients with a history of pancreatitis, and it is unknown if using JENTADUETO XR increases the risk of developing pancreatitis in these patients.

JDXR PROF ISI 24JUNE16

Please see Prescribing Information for JENTADUETO XR, including Boxed Warning regarding risk of lactic acidosis and Medication Guide.