empagliflozin/linagliptin

Drugs that Reduce Metformin Clearance Clinical Impact Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12.3) ] . Alcohol Clinical Impact Alcohol is known to potentiate the effect of metformin on lactate metabolism. ( 7 ) Drugs that Reduce...

Mechanism: Taking these medications together can cause metformin to build up in your blood because the kidneys cannot remove it as quickly. This increase can lead to a dangerous condition where too much acid builds up in your blood.

What to do: Your doctor should monitor your kidney function and may need to adjust your medication doses.

Drugs that Reduce Metformin Clearance Clinical Impact Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12.3) ] .

Mechanism: Dolutegravir blocks the kidneys from filtering metformin out of your blood, which makes metformin levels rise. Higher levels of metformin increase the risk of a serious health problem called lactic acidosis.

What to do: Your doctor may need to lower your metformin dose or check your blood levels more often.

Drugs that Reduce Metformin Clearance Clinical Impact Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12.3) ] .

Mechanism: Ranolazine prevents the kidneys from properly removing metformin from your system, leading to higher amounts of the drug in your body. This can increase the chance of developing a dangerous buildup of acid in your blood.

What to do: Talk to your doctor about monitoring your blood sugar and checking for signs of too much metformin in your system.

Drugs that Reduce Metformin Clearance Clinical Impact Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12.3) ] .

Mechanism: Cimetidine interferes with how the kidneys get rid of metformin, which can cause the drug to build up in your body. High levels of metformin increase the risk of a life-threatening condition called lactic acidosis.

What to do: Your healthcare provider may need to change your dose or watch your kidney health more carefully.

Diuretics Clinical Impact Coadministration of empagliflozin with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.

Mechanism: Both of these medicines increase how much you urinate. This can cause your body to lose too much water and become dehydrated.

What to do: Drink plenty of fluids and watch for signs of dehydration like dizziness. Your doctor may need to adjust your medication doses.