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DPP-4 Inhibitor (Gliptin) Pregnancy: Contraindicated — insufficient data. Use insulin.

Linagliptin

Brand names: Trajenta

Adult dose

Dose: 5mg OD
Route: Oral
Frequency: Once daily (with or without food)
Max: 5mg OD
Key advantage over other gliptins (sitagliptin, saxagliptin): primarily excreted via bile/gut — no dose adjustment needed in any degree of renal impairment, including dialysis. Preferred DPP-4i in renal impairment.

Paediatric dose

Route: Oral
Frequency: Once daily
Max: Not applicable
Not licensed under 18 years. Seek specialist opinion.

Dose adjustments

Renal

No dose adjustment required at any level of renal impairment — including eGFR <15 and dialysis. This is the principal advantage of linagliptin over sitagliptin.

Hepatic

No dose adjustment in mild-moderate hepatic impairment. Severe hepatic impairment: limited data, use with caution.

Clinical pearls

  • Linagliptin is the gliptin of choice in CKD — no renal dose adjustment, unlike sitagliptin (which requires dose reduction at eGFR <45) and alogliptin
  • DPP-4 inhibitors as a class reduce HbA1c by 0.5–0.9% — modest but well-tolerated
  • CARMELINA trial: linagliptin CV neutral — safe to use post-ACS
  • Bullous pemphigoid: if elderly patient develops blistering skin lesions on a DPP-4 inhibitor — stop drug and refer dermatology

Contraindications

  • Type 1 DM
  • DKA
  • Hypersensitivity to linagliptin or DPP-4 inhibitors

Side effects

  • Nasopharyngitis
  • Cough
  • Pancreatitis (rare)
  • Hypersensitivity including angioedema (rare)
  • Joint pain (arthralgia — class effect)
  • Bullous pemphigoid (class effect — discontinue if blistering rash develops)

Interactions

  • Rifampicin — CYP3A4/P-gp induction; reduces linagliptin efficacy significantly — avoid combination
  • Strong CYP3A4 inhibitors (ketoconazole) — modest increase in exposure, not clinically significant
  • Sulphonylureas/insulin — additive hypoglycaemia risk; reduce sulphonylurea dose

Monitoring

  • HbA1c 3–6 monthly
  • eGFR (annually — although no dose change needed)
  • Skin (blistering)
  • Pancreatitis symptoms if abdominal pain

Reference: BNFc; BNF 90; NICE NG28 (Type 2 DM); CARMELINA Trial (JAMA 2018). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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