Trijardy XR: The First Triple Combo Pill for Type 2 Diabetes

In January 2020, the U.S. Food and Drug Administration approved Trijardy XR for use in type 2 diabetes.  This is a combination pill that contains empagliflozin (Jardiance), linagliptin (Tradjenta), and metformin extended release, a trifecta of SGLT2-inhibitor, DPP4 inhibitor, and a biguanide, which are three classes of diabetes medications working together to lower blood sugar.

How do these three medications work separately?

  • Metformin has multiple modes of action, but mainly reduces glucose production by the liver. It is the first line medication recommended for patients with type 2 diabetes.
  • Empagliflozin (Jardiance), is an SGLT2 inhibitor that allows excess glucose elimination through the kidneys. In addition to their beneficial effects on improving glucose control, SGLT2 inhibitors as a class also promote weight loss, improve blood pressure, and reduce risk of coronary artery disease and strokes.  Moreover, they also prevent progression of renal disease from diabetes.  SGLT2-inhibitors are second line treatment recommended by the American Diabetes Association for type 2 diabetes, after metformin.
  • Linagliptin (Tradjenta) is a single dose DPP4-inhibitor in its class. This class of medications work by improving insulin secretion.

How do these medications work together?

People diagnosed with type 2 diabetes often experience significant pill burden.  Many also struggle with high blood pressure, high cholesterol, cardiac illnesses and kidney problems, which require lengthy lists of prescription medications.  Trijardy XR combines three commonly used antidiabetic medications into one fixed dose tablet.  Moreover, the added benefits of cardiovascular and renal protection (from Jardiance), and potential for weight loss from both metformin and Jardiance, make Trijardy XR a new and improved combination of familiar agents. In addition, none of the three medications cause hypoglycemia or low blood glucose.

Combination pills for type 2 diabetes are already commercially available, however, most include a sulfonylurea such as glipizide or glimepiride and metformin or a DPP4 inhibitor like Januvia and metformin (Janumet).  Trijardy XR is the first of a triple combo pill for type 2 diabetes that is now on the market.

Who is not a candidate for this combination pill?

  • Patients with type 1 diabetes or any patient with a history of diabetic ketoacidosis (elevated ketones in the urine), should not take Trijardy XR.
  • Linagliptin, a component of this combo pill, has a warning for pancreatitis or pancreatic inflammation. If you have a history of pancreatitis, discuss this with your doctor.
  • Trijardy XR is also not for people who have severe kidney problems, are on dialysis or have a history of lactic acidosis or liver failure, which are the same contraindications to metformin.

Who is a candidate for Trijardy?

  • Anyone with type 2 diabetes with an A1c that is not at goal, or who has weight problems or is at risk for hypoglycemia.

What doses are available?

Trijardy XR will be available in four different dosages:

  • 5 mg empagliflozin/2.5 mg linagliptin/1000 mg metformin HCl extended-release
  • 10 mg empagliflozin/5 mg linagliptin/1000 mg metformin HCl extended-release
  • 12.5 mg empagliflozin/2.5 mg linagliptin/1000 mg metformin HCl extended-release
  • 25 mg empagliflozin/5 mg linagliptin/1000 mg metformin HCl extended-release

Trijardy only requires one prescription and one co-pay. If you’re interested in trying Trijardy, talk to your provider to see if it would be a good option for your healthcare regimen.



  1. Avatar

    I am on dialysis. I am a Type 2 diabetic. Metformin was effective.I was taken off Metformin by my nephrologist for insulin. What about Trijardy?

    • Trijardy has metformin in it, but the other two medications are fine for folks on dialysis so you can take them separately.

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    I currently take Metformin, jardiance, and Truicity. Currently taking 2000 Metformin twice daily. Would Trijardy be better? When will it be available? I searched cans to price it and not found.

    • Trijardy is not the drug for you because it contains Linagliptin and it should not be taken with Trulicity. You are on a good regimen. Congrats.

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    I currently take Janumet and Actos. I have tried Tulicity in the past but could not tolerate the side effects of nausea and fatigue. My A1C has stayed a 6.3 since adding Actos last year. Would Trijardy be a good drug for me instead of the meds I’m on now?

  4. I currently am on 1000mg Metformin ER, 10 mg Jardiance, Victoza 1.8mg, Novalog 70/30 115 in AM & 95 in PM with 7.8 A1C. Is Trijardy be a good switch?

    • I realize it would be nice to condense your meds as you are on a bunch, which in reality is not unusual. Your control is pretty decent and a switch would not be giving you the same medications you are on now. If it ain’t broke….don’t fix it!

  5. Avatar

    I used Victoza with really good results (6.3 A1C) but lipase increased. Now I am on 1000mg Metformin, jardiance, and glipizide with 7.8 A1C. Would this be a good option?

    • I do think Trijardy may be a good replacement for the three orals you are on now. Linagliptin would replace glypizide and there may be advantages BUT you need to speak to your physician before making any changes. I am not your doctor!

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    QTern XR first approved Triple therapy FYI

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    is there a dr in omaha that i can see

  8. Avatar

    I tried Jardiance and found that I was allergic to it. So I continue taking metformin and have recently added Victoza.

  9. My a1c is 5.4 and I’m on ozempic 1x will and metformin 500mg 1x a day but my BS readings for over a week now at fasting 8+ hrs ha e been ranging between 175-180 and 2 hours after meals 200-250. I have changed nothing, my diet is the same, I’m not sick, exercise the same… My fasting reading was 80-100 when waking and 140-170 2 hrs after meal…. Would this pill be a good fit for me?

    • Hello Dani…not sure what is happening with your numbers now. You for sure need to keep walking, as your numbers were better. I would speak to your doctor about increasing your dose of metformin (you are on a tiny dose now) and also Ozempic which is an excellent medication. At this stage, trying that may be plan A and thinking about Trijardy would be plan B. I am not your doctor and really do not know much about you to make clinical decisions. Please discuss with your PCP/endo.

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