Indications Adina‑EM tablet is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Pharmacology

Linagliptin inhibits the DPP‑4 enzyme, which degrades incretin hormones (GLP‑1 and GIP). By increasing active incretin levels, it stimulates insulin release in a glucose‑dependent manner and decreases glucagon secretion, thereby improving glucose homeostasis.
Empagliflozin inhibits SGLT2 in the kidney, reducing renal glucose reabsorption and lowering the renal threshold for glucose, resulting in increased urinary glucose excretion.

Dosage & Administration

Recommended dose: 10 mg Empagliflozin + 5 mg Linagliptin once daily, in the morning, with or without food.
Increased dose: May be raised to 25 mg Empagliflozin + 5 mg Linagliptin once daily.
Renal impairment: Assess renal function before initiation. Do not start if eGFR < 45 mL/min/1.75 m². Discontinue if eGFR falls below this level.

Interactions

Diuretics: May increase urine volume and risk of volume depletion.
Insulin/secretagogues: Increased risk of hypoglycemia.
Strong P‑gp/CYP3A4 inducers (e.g., Rifampin): May reduce Linagliptin efficacy.
Urine glucose tests: May show false positives.
1.5‑AG assay: Results may be unreliable.

Contraindications

Severe renal impairment, end‑stage renal disease, or dialysis.
History of hypersensitivity to Linagliptin or Empagliflozin.

Side Effects

Pancreatitis, ketoacidosis, volume depletion, urinary tract infections, hypoglycemia, Fournier’s gangrene, genital mycotic infections, hypersensitivity reactions, disabling arthralgia, bullous pemphigoid, heart failure.

Pregnancy & Lactation Not recommended in 2nd and 3rd trimesters. Limited data in pregnancy. Risks exist with uncontrolled diabetes during pregnancy.

Precautions & Warnings

Pancreatitis, ketoacidosis, renal impairment, urinary tract infections, hypoglycemia, genital infections, hypersensitivity, arthralgia, bullous pemphigoid, heart failure risk.
Monitor patients closely for these conditions.

Overdose Effects In case of overdose, contact Poison Control. Use supportive measures, gastric decontamination, and clinical monitoring. Hemodialysis is unlikely to remove Linagliptin or Empagliflozin effectively.