title: Evaluation of the pharmacokinetic interaction between the dipeptidyl peptidase-4 inhibitor linagliptin and pioglitazone in healthy volunteers.
abstract: OBJECTIVE
  Co-administration of the dipeptidyl peptidase-4 inhibitor linagliptin (BI 1356) with pioglitazone may improve glycemic control in patients with Type 2 diabetes due to their complementary mechanisms of action. This study aimed to investigate any potential pharmacokinetic interaction between linagliptin and pioglitazone, a CYP 2C8 substrate.
  
  
  METHODS
  20 (10 male and 10 female) healthy subjects, between 22 and 65 years of age with a BMI range of > = 18.5 and < =29.9 kg/m2, took part in this single center open-label, randomized,two-way cross-over study. The subjects were administered linagliptin 10 mg/day and/orpioglitazone 45 mg/day until steady state was reached.
  
  
  RESULTS
  Co-administration of pioglitazone did not significantly affect linagliptin Cmax,ss (geometric mean ratio(GMR) 107.3; 90% confidence interval (CI);92.3 – 124.8) or AUC tau,ss (GMR 113.4; 90%CI 103.0 – 124.9). Co-administration of linagliptin did not significantly affect pioglitazoneAU tau,ss (GMR 94.4; 90% CI 87.1 –102.2), but reduced Cmax,ss by 14% (GMR85.6; 90% CI 78.1 – 93.8). As expected, linagliptin and pioglitazone were well tolerated,whether administered alone or concomitantly.There were no reported serious adverse events. The investigator defined 5 adverse events as drug-related with linagliptin,and 4 with pioglitazone.
  
  
  CONCLUSIONS
  Linagliptinand pioglitazone have no clinically relevant pharmacokinetic interaction and may be co-administered without dose adjustment.These data further confirm that linagliptin is not an inhibitor of CYP2C8 in vivo.As the pharmacokinetic profiles of linagliptin and pioglitazone are similar in Type 2 diabetes patients and healthy subjects, it is reasonable to assume that they may be administered together to Type 2 diabetes patients without dose adjustment.
authors.affiliation: 1Boehringer Ingelheim Pharma GmbH and Co. KG, Ingelheim, Germany. Ulrike.Graefe-Mody@boehringer-ingelheim.com
authors.forename: E U
authors.initials: EU
authors.lastname: Graefe-Mody
authors.forename: A
authors.initials: A
authors.lastname: Jungnik
authors.forename: A
authors.initials: A
authors.lastname: Ring
authors.forename: H J
authors.initials: HJ
authors.lastname: Woerle
authors.forename: K A
authors.initials: KA
authors.lastname: Dugi
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000493:pharmacokinetics*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics*; D000069476:Linagliptin; D008297:Male; D008875:Middle Aged; D000077205:Pioglitazone; D011687:Purines / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D011799:Quinazolines / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology; D045162:Thiazolidinediones / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000494:pharmacology
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D011687:Purines; D011799:Quinazolines; D045162:Thiazolidinediones; D000069476:Linagliptin; D000077205:Pioglitazone