Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Alcohol intake: Alcohol increases the risk of developing lactic acidosis for people taking metformin. If you are taking this medication avoid excessive alcohol intake. If you drink alcohol often or heavily, discuss with your doctor how this medication may affect you, how your alcohol intake may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Blood sugar monitoring: Monitor your blood sugar regularly at intervals as discussed with your doctor or diabetes educator.
Congestive heart failure and heart disease: The safety and effectiveness of linagliptin has not been established for people with congestive heart failure (CHF) or heart disease. For this reason, this medication is not recommended for people with CHF or heart disease.
If you have CHF or heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether this medication is appropriate for you.
Dye or contrast agents: If you are going to have an X-ray procedure that uses dye or a contrast agent, you may need to stop taking this medication for a short time. Contact your doctor for instructions.
Hypoglycemia (low blood sugar): Hypoglycemia can occur when linagliptin - metformin is used in combination with a sulfonylurea (e.g., glyburide, gliclazide). Your doctor may suggest a lower dose of your sulfonylurea when you start this medication.
Hypoglycemia may also occur when you don't eat enough, you exercise strenuously without eating enough or drink alcohol. If you experience low blood sugar (e.g., headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, fast heartbeat, sweating, and feeling jittery) contact your doctor.
During times of stress (e.g., fever, trauma, surgery, infection), your doctor may suggest that you temporarily stop this medication and use insulin to help control your blood sugar levels.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects and increasing the risk of lactic acidosis. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: If you have reduced liver function or liver disease, you may be at an increased risk of developing lactic acidosis. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. This medication is not recommended if you have severely reduced liver function.
Pancreatitis: This medication may cause or worsen pancreatitis (inflammation of the pancreas). If you have a history of pancreatitis, gallstones, alcoholism, or high triglycerides, you may be more at risk of experiencing this and should be closely monitored by your doctor while taking this medication.
If you experience symptoms of pancreatitis (e.g., upper left abdominal pain, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen or prolonged and severe abdominal pain with or without vomiting), contact your doctor immediately.
Lactic acidosis: Lactic acidosis is a rare but serious problem that occurs due to metformin accumulation (i.e., the body doesn't get rid of it fast enough) during treatment. If you have severe kidney disease you are at higher risk of developing lactic acidosis. Since alcohol may increase the risk of lactic acidosis, do not drink a lot of alcohol over the short- or long-term while taking this medication. When it does occur (very rarely), it is fatal in 50% of cases. If you experience symptoms of lactic acidosis (e.g., weakness, tiredness, drowsiness, unusual muscle pain, trouble breathing, stomach pain with nausea, vomiting or diarrhea, feeling cold, dizziness, light-headedness, or slow or irregular heartbeat), stop taking this medication and get immediate medical attention.
Vitamin B12 levels: Metformin may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking this medication.
Pregnancy: Metformin should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately. During pregnancy, blood glucose levels should be kept as close to normal as possible using insulin.
Breast-feeding: It is not known if linagliptin passes into breast milk. Metformin does pass into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. The use of linagliptin - metformin in women who are breast-feeding is not recommended.
Children: The safety and effectiveness of using this medication have not been established for children less than 18 years old.
Seniors: Seniors are more likely to have reduced liver and kidney function, and may be at increased risk of experiencing side effects to this medication.