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.
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.
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.
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?
With an A1c of 6.3% you should not change a thing!
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!
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!
QTern XR first approved Triple therapy FYI
is there a dr in omaha that i can see
Hi Deb,
It really depends on your insurance. If you would like to email me I will do my best to assist you. My email is lynne@tcoyd.org.
I tried Jardiance and found that I was allergic to it. So I continue taking metformin and have recently added Victoza.
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.
I am a newly diagnosed (day before Thanksgiving) Type 2 diabetic. My initial a1c was an 8.9. Dr put me on TrijardyXR 12.5/2.5/1000 once a day in the evening. I immediately began following a 45 carb per meal diet with 15 for snacks. Also walking 3 miles a day, 6 days a week. After 3 months my a1c is at 5.4. Dr wants me to continue Trijardy but it is so expensive and my insurance does not cover it. Would Metformin alone do the job for me? I am not overweight (6’6” 205lbs)
I would say that because you’ve done such a good job with lifestyle modifications, it’s highly likely that metformin would do the job, but you need to also get your doctor on board.
I started me on metformin 750.
Original A1C level was 9.1
It didn’t move much at first with the 750 metformin so they shot me on to 1500 along with the pioglitz zone 30 mg.
Well then 6 months the A1C went down to a reading of 8.1.
6 months later it went up again not much but just a little bit to 8.3.
So now they said stay with the pio glitz zone 30 mg and also the Trijardy XR 1500 two pills a day for a total of 3,000 mg.
My doctor said sometimes your A1C stalls and that’s exactly what it did out of nowhere so he thinks what the tragedy within about 6 months to a year I might be almost into close to the 6.5 range he said which would be awesome.
I don’t know what to expect as far as side effects but I really haven’t had nothing the first week I’ve been on it which I guess is a start can only hope for the best.
It’s neat how you can get metformin and then two other drugs into a three-in-one pill for those with diabetes type 2 non-insulin dependent and attack so many good areas that metformin only does in one area so I’m hoping for the best
Absolutely – it’s an excellent combination.