SGLT2 inhibitor + DPP-4 inhibitor (fixed-dose)
Empagliflozin with linagliptin
Brand names: Glyxambi
Adult dose
Dose: 10/5mg or 25/5mg OD
Route: Oral
Frequency: OD
Clinical pearls
- NICE NG28 type 2 diabetes pathway: SGLT2i + DPP-4i combination per local formulary
- ADA-EASD consensus supports SGLT2i in CV/renal risk
- MHRA: euglycaemic DKA warning; 'sick day' rules for SGLT2i pause
Contraindications
- Type 1 diabetes
- DKA history
- eGFR <30mL/min/1.73m² (initiation)
- Severe hepatic impairment
- Pregnancy
- Hypersensitivity
Side effects
- Genitourinary infections
- Volume depletion
- DKA (atypical, normoglycaemic)
- Fournier's gangrene (rare)
- Pancreatitis (DPP-4 effect)
- Joint pain
Interactions
- Diuretics
- RAAS inhibitors
- Insulin/sulfonylureas (hypoglycaemia)
- Strong CYP3A4 inducers (reduce linagliptin levels)
Monitoring
- HbA1c
- eGFR
- Volume status
- Foot care
- Sick-day SGLT2i rules
Reference: BNF; NICE NG28; MHRA Drug Safety Update; ADA-EASD consensus; https://bnf.nice.org.uk/drugs/empagliflozin-with-linagliptin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Warfarin Dose Adjustment Calculator · Anticoagulation
- SCORE2-Diabetes 10-Year CVD Risk in Type 2 Diabetes · Cardiovascular Risk
- PCP-HF Risk Score (Pooled Cohort Equations to Prevent Heart Failure) · Heart Failure Prevention
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016