Home Drug Guide Empagliflozin and Linagliptin

Drug Guide

Generic Name

Empagliflozin and Linagliptin

Brand Names Jardiance and Tradjenta

Classification

Therapeutic: Antidiabetic agents

Pharmacological: SGLT2 inhibitor (Empagliflozin) and DPP-4 inhibitor (Linagliptin)

FDA Approved Indications

  • Type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Empagliflozin inhibits SGLT2 in the proximal tubules of the kidney, reducing glucose reabsorption and increasing urinary glucose excretion. Linagliptin inhibits DPP-4, prolonging the action of incretin hormones, which increase insulin secretion and decrease glucagon levels in a glucose-dependent manner.

Dosage and Administration

Adult: Typically 10 mg empagliflozin once daily and 5 mg linagliptin once daily, adjustable based on response.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution in elderly; monitor renal function.

Renal Impairment: Adjustments may be necessary; contraindicated if eGFR is below certain thresholds.

Hepatic Impairment: No dose adjustment needed.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Widely distributed; Empagliflozin highly protein-bound, Linagliptin extensively binds to plasma proteins.

Metabolism: Empagliflozin primarily metabolized via glucuronidation; Linagliptin undergoes minimal CYP metabolism.

Excretion: Empagliflozin mainly excreted in feces and urine; Linagliptin primarily excreted via enterohepatic system.

Half Life: Empagliflozin approximately 12 hours; Linagliptin approximately 115 hours.

Contraindications

  • Hypersensitivity to the components.
  • Severe renal impairment (eGFR < 30 mL/min/1.73 m²).

Precautions

  • Risk of urinary tract infections, genital mycotic infections, dehydration, diabetic ketoacidosis, and hypoglycemia when used with insulin or insulin secretagogues.

Adverse Reactions - Common

  • Urinary tract infections (Common)
  • Genital mycotic infections (Common)
  • Increased urination (Common)

Adverse Reactions - Serious

  • Euglycemic diabetic ketoacidosis (Rare)
  • Acute kidney injury (Rare)
  • Hypoglycemia (Less common)

Drug-Drug Interactions

  • Diuretics, insulin, insulin secretagogues, other antihyperglycemic agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels, renal function, signs of dehydration, and infections.

Diagnoses:

  • Risk for infection
  • Risk for dehydration
  • Ineffective tissue perfusion related to hypovolemia.

Implementation: Administer as prescribed, monitor labs, educate patient on signs of adverse effects and infection prevention.

Evaluation: Assess blood glucose control, patient understanding, and adherence to therapy.

Patient/Family Teaching

  • Keep hydrated, recognize signs of urinary infections, do not use during severe renal impairment, report symptoms of ketoacidosis, adhere to prescribed diet and medication regimen.

Special Considerations

Black Box Warnings:

  • Risk of ketoacidosis; risk factors include acute illness, dehydration, and alcohol use.

Genetic Factors: N/A

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Severe dehydration, hypotension, hypoglycemia, ketoacidosis.

Treatment: Supportive care, hydration, correction of electrolyte and glucose imbalances, hospitalization if needed.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.