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This distinctive elimination pathway positions Linagliptin as the DPP-4 inhibitor of choice for patients with all stages of kidney failure, as it does not require dose adjustments

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However, due to the ability of the drugs to improve fertility in women with obesity, and their ability to reduce effectiveness of the oral contraceptive pill due to delayed gastric emptying, there are a rapidly increasing number of cases of exposure to GLP1RAs in early pregnancy where women have become pregnant while taking one of the drugs