Nurses Compass
Drug Guide
Empagliflozin and Linagliptin
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/ADrug-Herb Interactions
N/ANursing 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.