Bexarotene
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Linagliptin
Dipeptidyl peptidase-4 (DPP-4) inhibitor (gliptin) · Antidiabetic
Also known as Trajenta
START
5 mg PO once daily (no titration; no renal/hepatic adjustment)
TYPICAL MAX
5 mg/day (fixed)
STOP IF
Acute pancreatitis, severe hypersensitivity (angioedema/SJS), bullous pemphigoid, disabling arthralgia
WATCH
Pancreatitis symptoms, severe joint pain, skin (pemphigoid), HbA1c; hypoglycaemia if with sulfonylurea/insulin
CDSCO approvedSchedule HATC A10BH05
KDIGO 2024 + manufacturer label
- ONSET
- 1h · DPP-4 inhibition
- PEAK
- 1.5h · Cmax
- t½
- 12h · effective t½
- DURATION
- 1d · once-daily
EXCRETION
~80% biliary/faecal; <5% renal
route + CYP
INTERACTIONS
3 major
SEVERE in our sources
PREGNANCY
Avoid — limited data; insulin preferred in pregnancy
FDA category + note
Top interactionssee all 7 →
- BexaroteneSevereDatabaseDDInter
- GatifloxacinSevereDatabaseDDInter
- SulfonylureasSevereDatabaseKimi deep-research + Cla
Available in India
15 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Inhibits DPP-4, prolonging endogenous incretins (GLP-1, GIP) → glucose-dependent insulin secretion and reduced glucagon; weight-neutral, low intrinsic hypoglycaemia risk; uniquely non-renally eliminated.
Indications
Type 2 diabetes mellitus (monotherapy or add-on to metformin, sulfonylurea, insulin, etc.)
Dosing
- Adult
- 5 mg PO once daily (with or without food).
- Pediatric
- Not established.
- Renal adjustment
- No dose adjustment at any level of renal impairment (primarily biliary/enterohepatic elimination).
- Hepatic adjustment
- No dose adjustment (limited severe-impairment data).
- Geriatric
- No specific adjustment.
- Max dose
- 5 mg/day (fixed)
Pharmacokinetics
Onset
DPP-4 inhibition within ~1 h; glycaemic effect over weeks
Peak effect
Cmax ~1.5 h
Duration
~24 h (long DPP-4 occupancy)
Half-life
Effective ~12 h (terminal long due to target binding)
Bioavailability
~30%
Protein binding
Concentration-dependent (high, saturable)
Metabolism
Minimal (mostly unchanged)
Excretion
Predominantly biliary/faecal (~80%); <5% renal
Contraindications
- Type 1 diabetes / diabetic ketoacidosis
- History of serious hypersensitivity to linagliptin (angioedema, anaphylaxis, SJS)
Side effects
Common
NasopharyngitisHypoglycaemia (with sulfonylurea/insulin)HeadacheArthralgia (class)
Serious
- Acute pancreatitis
- Severe hypersensitivity (angioedema, anaphylaxis, SJS)
- Severe disabling arthralgia (DPP-4 class)
- Bullous pemphigoid
- Possible heart-failure hospitalisation signal (class — agent-variable)
Pregnancy & lactation
Pregnancy
Avoid — limited data; insulin preferred in pregnancy
Lactation
Avoid (excreted in animal milk)
Drug interactions
Gatifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Sulfonylureas
Severe
Database
Additive hypoglycaemia
Reduce sulfonylurea/insulin dose; monitor glucose
Source: Kimi deep-research + Cla
Ace Inhibitors
Moderate
Database
Possible additive angioedema risk (DPP-4 class)
Monitor for angioedema
Source: Kimi deep-research + Cla
Glp 1 Receptor Agonists
Moderate
Database
Overlapping incretin mechanism — no added benefit, possible GI/pancreatitis additive
Avoid combining DPP-4 inhibitor with GLP-1 agonist
Source: Kimi deep-research + Cla
Rifampicin
Moderate
Database
Reduced glucose-lowering efficacy
Monitor glucose. Consider alternative DPP-4i.
Source: DDInter
Strong Cyp3a4 + P Gp Inducers
Moderate
Database
Reduced linagliptin exposure → loss of efficacy
Consider alternative agent if chronic rifampicin
Source: Kimi deep-research + Cla
5 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Fluid and electrolyte management in diabetes
RSSDI · Endocrinology · 2025
Diabetes management during Ramadan
ADA · Endocrinology · 2025
Glucose monitoring in diabetes
RSSDI · Endocrinology · 2024
Gestational diabetes mellitus
FOGSI · Obstetrics & Gynaecology · 2023
Type 2 diabetes in adults
ICMR · Endocrinology · 2022
Other Dipeptidyl peptidase-4 (DPP-4) inhibitor (gliptin) drugs
Ask House about Linagliptin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19