In this video, Dr. Kalra speaks about safety, efficacy, and tolerability of linagliptin and metformin combination therapy. He detailed how it can help the clinician to ease their decision making and troubleshooting in antidiabetic therapy.
In clinical practice multiple factors determine our choice of therapy the american association of clinical endocrinology recommends that we should start therapy with dual therapy or dual drugs that is two drugs if the hba1c at presentation is more than 7.5% in an indian opd almost all our patients have an entry hba1c of more than seven point five so it makes sense
Therefore for us to start therapy with two drugs instead of it metformin mono therapy if we decide that we wish to start therapy with two drugs we have to choose drugs which are not only efficacious in controlling even see but which are also safe well tolerated and which have a synergistic effect with each other we’ve seen the evidence that linagliptin and metformin
Can control hba1c in a very safe manner without causing hypoglycemia without causing any other side effects one advantage i would like to highlight here is that linagliptin is able to increase the sensitivity of the alpha cell not only does it reduce glucagon levels it also increases the sensitivity of the alpha cell so that in a situation where hypoglycemia occurs
Glucagon release is encouraged what this means for us in practices that we can use linagliptin plus metformin combination along with insulin as well and we can assume that there will be lesser hypoglycemia if we add linagliptin to an insulin based regime the american association of clinic and in technologies suggests dual or triple combination therapy because it is
Understood that with any mono therapy whether metformin or any other drug you cannot bring it to even see down more than one percent because of this we tend to use linagliptin and metformin f disease in practice but it’s not efficiency alone helps us decide what therapy to give and what not to give we also worry about safety and tolerability with the linagliptin
Based combination you actually do not have to worry about these things because there are hardly any contraindications in any situation where insulin is not mandatory linagliptin can be used metformin also in the past few months has seen its lists of indications expanding and its list of contraindications contracting so now we use it much more freely in patients
With mild or moderate renal impairment of course we do keep a watch on gfr and on creatinine levels but in general we are much more confident using it in clinical situations where earlier insulin was the only drug of choice so in a busy practice like you and i have we do not have to think much about whether to prescribe or not to prescribe unit lipton + metformin
Combination because there are hardly any contraindications to this another issue which we consider in clinical practice is that of tolerability so if you have an effective drug which causes a lot of side effects and then you have the patient coming back to you complaining demanding troubleshooting then this drug is not going to be welcomed in practice in our clinics
With linagliptin plasmid foreman there is no issue for tolerability it is tolerated as well as a placebo is and therefore again it makes it scent it makes sense for us to use it freely in a busy clinical practice the major advantage of this combination in my practice however is that of patient acceptance patient acceptance is determined by efficacy obviously also
By tolerability and also by ease-of-use so for example if i have a drug which i have to give exactly 30 minutes before a meal with a huge big glass of water at the same time every day what this causes is something known as intrusion and we term it the index of intrusion of a particular drug or a particular therapy presented oh hardly intrudes into anybody’s life
You can give it before meals with meals or after meals i really it should be used twice a day but it is not mandatory to give it at 12 hourly intervals because let’s look at the pharmacokinetics for lena lipton you might want to give a 5 milligram dose once daily or 2.5 milligram dose twice daily it is not mandatory to give the 2.5 milligram dose twice daily at
12 early intervals so therefore you can give it for example with breakfast and lunch or with lunch and dinner if these are the two main meals of the day for metformin as long as you have maintained the 5 to 6 r gap the drug can be given in to succeeding meals so you can give it at any two consecutive meals provided those are the 2 main meals or heavy meals of the
Day it has this advantage in timing of administration in change in time ago administration lack of side effects very good efficacy which makes it a preferred drug for use both for the physician and for the patient one of the main challenges that i face in clinical practice is that of troubleshooting so let’s say i have prescribed a sulfonylurea or any other drug
Which causes side effects the side effect may be weight gain it may be hypoglycemia it may be gastrointestinal side effects if the patient keeps on coming back to me repeatedly with these complaints asking for troubleshooting it tends to reduce my efficiency it reduces the efficiency of my clinic and the final negative impact is on patients because then we are
Not able to serve as many people as we would like to with linagliptin plus metformin combination we have none of these problems it’s easy to prescribe it’s easy for the patient to take it gives good results and because of that we tend to use it more and more often in our practice it’s been nice interacting with you today and i look forward to such interaction in
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Transcribed from video
Safety, Efficacy and Tolerability of Combination Therapy in Diabetes By Docplexus