Tradimet^®

Tradimet®

Tradimet® contains two drugs: linagliptin and metformin.
Linagliptin is a DPP-4 (Dipeptidyl Peptidase-4) enzyme inhibitor that increases insulin secretion and reduces glucagon secretion.
Metformin is a biguanide that prevents high blood sugar by reducing glucose production in the liver, decreasing its absorption in the gastrointestinal tract, and reducing insulin resistance.

Indications for Use:

• Type 2 Diabetes treatment in adults.

Dosage Forms:

• Oral tablets in three strengths:
• 2.5/500 mg
• 2.5/1000 mg
• 5/1000 mg
• Extended-release oral tablets in two strengths:
• 2.5/1000 mg
• 5/1000 mg

How to Use:

• Tradimet® should be taken as directed by your doctor. If you're unsure about how to use the medication properly, consult your doctor or pharmacist.
• For optimal therapeutic response, do not alter the dosage or duration of treatment without consulting your doctor.
• Take Tradimet® once a day with a meal. Do not crush, break, dissolve, or chew the tablets.

Missed Dose:

• Take the missed dose as soon as you remember.
• If it is near the time for your next dose, skip the missed dose and do not double the dose.

Overdose:

• If you take more than the recommended dose, immediately seek medical attention.
• Overdosing can cause hypoglycemia (low blood sugar). Symptoms of hypoglycemia may include headache, drowsiness, weakness, irritability, hunger, increased heart rate, body tremor , blurred vision, confusion, and sweating. In such cases, consume a sweet drink (like fruit juice) or a sugary food (like sugar ).

Monitoring During Treatment:

• Blood glucose and HbA1c levels
• Kidney function
• Symptoms of heart failure
• Symptoms of pancreatitis
• Blood parameters like hemoglobin and hematocrit
• Vitamin B9 (folate) levels in case of suspected megaloblastic anemia
• Vitamin B12 levels with long-term use

Contraindications:

• History of allergy to linagliptin, metformin, or any other components of the formulation.
• Insulin-dependent diabetes (Type 1)
• Severe kidney failure or patients on dialysis
• Acute or chronic metabolic acidosis
• History of diabetic ketoacidosis or lactic acidosis
• Excessive alcohol consumption (acute or chronic)
• Severe liver dysfunction
• Cardiovascular collapse and hypoxemic-related diseases, including heart failure and respiratory failure
• Close to intravenous contrast administration for radiological investigations
• Severe stress conditions such as severe infections, trauma, surgery, or post-operative recovery
• Severe dehydration and shock
• Pregnancy and breastfeeding

Warnings and Precautions:

• Simultaneous use of two or more anti-diabetic drugs, especially sulfonylureas and insulin, increases the risk of hypoglycemia. Always consult with your doctor for the correct dosage and combination.
• Excessive doses of this drug due to the metformin component may cause lactic acidosis. Conditions such as kidney failure, age over 65, radiological contrast use, severe infections, major surgeries, severe burns, alcohol use, and liver disorders increase the risk. Symptoms of lactic acidosis include fatigue, weakness, muscle pain, abdominal pain, rapid and shallow breathing, and drowsiness, which can lead to lowered body temperature, blood pressure, and heart rate. If any of these symptoms occur, seek immediate medical help.
• If symptoms of diabetic ketoacidosis (e.g., nausea, vomiting, abdominal pain, fatigue, and shortness of breath) occur, seek medical attention immediately.
• This medication may cause dehydration, leading to low blood pressure and kidney damage. Symptoms may include dizziness, weakness, lightheadedness, or fatigue. Ensure you stay hydrated, especially if using diuretics like furosemide, hydrochlorothiazide, or spironolactone. Consult your doctor if these symptoms occur.
• As glucose is excreted in urine while using Tradimet®, urine tests for glucose may yield false-positive results. Inform your doctor about this medication.
• If you have had an allergic reaction to any anti-diabetic medication in the past, inform your doctor.
• Notify your doctor if you experience any signs of pancreatitis (e.g., persistent abdominal pain).
• To reduce the risk of ketoacidosis, it is recommended to stop Tradimet® three days before undergoing surgery.
• Long-term use of this medication may lead to vitamin B12 deficiency. Discuss with your doctor if this occurs.
• Tradimet® may cause joint pain, which typically resolves after discontinuing the medication. Consult your doctor if this occurs.
• The medication may cause skin lesions or blisters (bullous pemphigoid), which resolve after stopping the drug. Notify your doctor if these symptoms appear.

Use During Pregnancy and Breastfeeding:

• Tradimet® is not recommended for those planning to become pregnant.
• Tradimet® may increase the risk of unintended pregnancy, particularly in women with irregular menstrual cycles. Use a reliable form of contraception while taking Tradimet®.
• Due to potential risks to the fetus, Tradimet® is not recommended during pregnancy.
• It is unclear whether this medication is excreted in breast milk. Due to potential risks to the infant, breastfeeding is not recommended during treatment with Tradimet®.

Side Effects:

Like all medications, Tradimet® may cause side effects. Not everyone will experience these, but possible side effects include:

• Hypoglycemia (low blood sugar)
• Acute kidney injury
• Severe joint pain
• Allergic reactions
• Low blood pressure
• Diabetic ketoacidosis
• Lactic acidosis
• Vitamin B12 deficiency
• Gastrointestinal discomfort (e.g., nausea, vomiting, diarrhea, loss of appetite)
• Weakness and headache
• Cold-like symptoms such as cough and sore throat

Drug Interactions:

Consult your doctor or pharmacist about any interactions between Tradimet® and other medications or supplements.

Packaging:

Each package of Tradimet® contains 30 tablets in a bottle.

Storage Conditions:

• Store Tradimet® below 30°C, away from light and moisture.
• Do not use the medication after the expiration date.
• Keep out of the reach of children.
• Keep the medication in its original packaging until use.

References:

1. Medicines.org.uk
2. Linagliptin and Metformin: Drug information, UpToDate 2024