Trajenta Duo Dosage/Direction for Use

Adults with normal renal function (GFR ≥90mL/min): The recommended dose is 2.5/500 mg, 2.5/850 mg or 2.5/1 g twice daily.
The dosage should be individualised on the basis of the patient's current regimen, effectiveness, and tolerability. Maximum recommended daily dose of Linagliptin + Metformin HCl (Trajenta Duo) is 5 mg of linagliptin and 2 g of metformin (see Table 5 for additional dosing information).
Linagliptin + Metformin HCl (Trajenta Duo) should be given with meals to reduce the gastrointestinal undesirable effects associated with metformin.
For patients currently not treated with metformin: For patients currently not treated with metformin, the recommended starting dose is 2.5 mg linagliptin/500mg metformin hydrochloride twice daily.
For patients inadequately controlled on maximal tolerated dose of metformin monotherapy: For patients not adequately controlled on metformin alone, the usual starting dose of Linagliptin + Metformin HCl (Trajenta Duo) should provide linagliptin dosed as 2.5 mg twice daily (5 mg total daily dose) plus the dose of metformin already being taken.
For patients switching from co-administration of linagliptin and metformin: For patients switching from co-administration of linagliptin and metformin to the fixed dose combination, Linagliptin + Metformin HCl (Trajenta Duo) should be initiated at the dose of linagliptin and metformin already being taken.
For patients inadequately controlled on dual combination therapy with the maximal tolerated dose of metformin and a sulphonylurea: The dose of Linagliptin + Metformin HCl (Trajenta Duo) should provide linagliptin dosed as 2.5 mg twice daily (5 mg total daily dose) and a dose of metformin similar to the dose already being taken. When Linagliptin + Metformin HCl (Trajenta Duo) is used in combination with a sulphonylurea, a lower dose of the sulphonylurea may be required to reduce the risk of hypoglycaemia (see Precautions).
For patients inadequately controlled on dual combination therapy with insulin and the maximal tolerated dose of metformin: The dose of Linagliptin + Metformin HCl (Trajenta Duo) should provide linagliptin dosed as 2.5 mg twice daily (5 mg total daily dose) and a dose of metformin similar to the dose already being taken. When Linagliptin + Metformin HCl (Trajenta Duo) is used in combination with insulin, a lower dose of insulin may be required to reduce the risk of hypoglycaemia (see Precautions).
For the different doses on metformin, Linagliptin + Metformin HCl (Trajenta Duo) is available in strengths of 2.5 mg linagliptin plus 500 mg metformin hydrochloride, 850 mg metformin hydrochloride or 1 g metformin hydrochloride.
Renal impairment: A GFR should be assessed before initiation of treatment with metformin containing products and at least annually thereafter.
In patients at an increased risk of further progression of renal impairment and in the elderly, renal function should be assessed more frequently, e.g. every 3-6 months.
Factors that may increase the risk of lactic acidosis (see Precautions) should be reviewed before considering initiation of metformin in patients with GFR <60 mL/min. (See Table 5.)

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Hepatic impairment: Linagliptin + Metformin HCl (Trajenta Duo) is contraindicated in patients with hepatic impairment due to the metformin component (see Contraindications).
Geriatric patients: As metformin is excreted via the kidney, and elderly patients have a tendency for decreased renal function, elderly patients taking Linagliptin + Metformin HCl (Trajenta Duo) should have their renal function monitored regularly (see Precautions).
Paediatric patients: Linagliptin + Metformin HCl (Trajenta Duo) is not recommended for use in children below 18 years due to lack of data on safety and efficacy.
Missed dose: If a dose is missed, it should be taken as soon as the patient remembers.
However, a double dose should not be taken at the same time. In that case the missed dose should be skipped.