1. About saxagliptin
Saxagliptin is a medicine used to treat type 2 diabetes. Type 2 diabetes is an illness where the body does not make enough insulin, or the insulin that it makes does not work properly.
This can cause high blood sugar levels (hyperglycaemia).
Saxagliptin is prescribed for people who have high blood sugar even though they have a sensible diet and exercise regularly.
Saxagliptin is only available on prescription.
It comes as tablets that you swallow. It also comes as tablets containing a mixture of saxagliptin and metformin or saxagliptin and dapagliflozin.
Metformin and dapagliflozin are other drugs used to treat diabetes.
2. Key facts
- Saxagliptin works by increasing the amount of insulin that your body makes. Insulin is the hormone that controls sugar levels in your blood.
- You take saxagliptin once a day.
- The most common side effects of saxagliptin are diarrhoea or stomach ache.
- This medicine does not usually make you put on weight.
- Saxagliptin is also called by the brand name Onglyza. When combined with metformin it's called Komboglyze, and Qtern when mixed with dapagliflozin.
3. Who can and can't take saxagliptin
Saxagliptin can be taken by adults (aged 18 years and older).
Saxagliptin is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
- have had an allergic reaction to saxagliptin or any other medicines in the past
- have kidney disease or liver disease
- have heart failure
- have (or have previously had) problems with your pancreas
- are at increased risk of infection (after an organ transplant or because of a condition like AIDS)
- are pregnant or breastfeeding, or trying to get pregnant
This medicine is not used to treat type 1 diabetes (when your body does not produce insulin).
4. How and when to take it
Take saxagliptin once a day.
You can take it at any time - for example, in the morning or in the evening. Just try to take it at the same time every day.
Take your tablet with a glass of water. Swallow the tablet whole, without breaking it.
You can take sitagliptin with or without food.
How much will I take?
Saxagliptin comes as 2.5mg or 5mg tablets.
The usual dose is 5mg a day.
Your doctor might give you a lower dose of 2.5mg a day if you:
- have problems with your kidneys
- take other diabetes medicines, such as insulin
What if I take too much?
Urgent advice: Talk to your doctor if you take too much saxagliptin and:
- have stomach pains
- are feeling or being sick (nausea or vomiting)
- feel dizzy
- are worried
What if I forget to take it?
Take the missed dose as soon as you remember, unless it's nearly time for your next dose.
In this case, skip the missed dose and take your next dose at the usual time.
Never take 2 doses on the same day.
If you forget doses often, it may help to set an alarm to remind you.
You could ask your pharmacist for advice on other ways to remember to take your medicines.
5. Side effects
Like all medicines, saxagliptin can cause side effects in some people.
But many people have no side effects or only minor ones.
Common side effects
These common side effects happen in more than 1 in 100 people.
Talk to your doctor or pharmacist if these side effects bother you or do not go away:
- feeling dizzy or weak
- stomach pains
- feeling or being sick (nausea or vomiting)
- urinary tract infections (UTIs)
- cold-like symptoms
- mild rash
Serious side effects
It happens rarely, but some people may have serious side effects after taking saxagliptin.
Call your doctor straight away if you have:
- severe stomach pains
- yellowing of your skin or the whites of your eyes turn yellow
Low blood sugar
Saxagliptin does not usually cause low blood sugar (known as hypoglycaemia, or "hypos") when taken on its own.
But hypos can happen when you take saxagliptin with other diabetes medicines, such as insulin or gliclazide.
Early warning signs of low blood sugar include:
- feeling hungry
- trembling or shaking
- difficulty concentrating
It's also possible for your blood sugar to go too low while you're asleep.
If this happens, it can make you feel sweaty, tired and confused when you wake up.
Low blood sugar may happen if you:
- take too much of some types of diabetes medicines
- eat meals irregularly or skip meals
- are fasting
- do not eat a healthy diet and are not getting enough nutrients
- change what you eat
- increase your physical activity without eating more to compensate
- drink alcohol, especially after skipping a meal
- take some other medicines or herbal medicines at the same time
- have a hormone disorder, such as hypothyroidism
- have kidney or liver problems
To prevent hypos, it's important to have regular meals, including breakfast. Never miss or delay a meal.
If you're planning to exercise more than usual, make sure you eat carbohydrates like bread, pasta or cereals before, during or after exercise.
Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.
You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.
If taking in sugar does not help or the hypo symptoms come back, contact your doctor or the nearest hospital.
Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.
Serious allergic reaction
It's possible to have a serious allergic reaction (anaphylaxis) to saxagliptin.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of saxagliptin.
For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- feeling dizzy or weak - stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling dizzy or tired. Do not drink alcohol as it'll make you feel worse.
- headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
- diarrhoea - drink plenty of water or other fluids to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- stomach ache - try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your tummy may also help. If you're in a lot of pain, speak to your pharmacist or doctor.
- feeling or being sick (nausea or vomiting) - try taking saxagliptin with or after food to see if that helps. Try to eat smaller, more frequent meals. If you're being sick, try having small, frequent sips of water.
- urinary tract infections (UTIs) - talk to your pharmacist or doctor if you have symptoms of a UTI. These include needing to pee suddenly or more often, pain when peeing, smelly or cloudy pee, or pain in your lower belly. Drink plenty of water and take paracetamol to ease the pain if you need to.
- cold-like symptoms - try taking paracetamol or ibuprofen regularly for a few days. If the symptoms return when you stop taking the painkillers, ask your doctor for advice.
- mild rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If your rash gets worse or lasts for more than a week, make an appointment to see your doctor.
7. Pregnancy and breastfeeding
Saxagliptin is generally not recommended in pregnancy or while breastfeeding.
Your doctor will only prescribe saxagliptin while you're pregnant or breastfeeding if the benefits of taking the medicine outweigh the risks.
Saxagliptin and breastfeeding
Small amounts of saxagliptin get into breast milk. But it has not been linked with any side effects in breastfed babies.
Talk to your doctor if you want to breastfeed. They may recommend taking a different medicine.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines and saxagliptin can interfere with each other. Some can increase your risk of getting side effects.
Tell your doctor if you're taking:
- dexamethasone (a steroid used for many conditions, including arthritis and cancer)
- carbamazepine, phenobarbital or phenytoin (medicines for seizures)
- diltiazem (a medicine for high blood pressure)
- ketoconazole (a medicine for fungal infections)
- rifampicin (an antibiotic used in treating TB and other bacterial infections)
- insulin or any other diabetes medicines, such as gliclazide, glipizide, glibenclamide, glimepiride or tolbutamide
Make sure that your doctor and pharmacist know you're taking saxagliptin before starting or stopping any other medicine.
Mixing saxagliptin with herbal remedies and supplements
There's very little information about taking herbal remedies and supplements with saxagliptin.
For safety, tell your doctor and pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does saxagliptin work?
Saxagliptin belongs to a group of medicines called dipeptidylpeptidase-4 inhibitors (DPP-4 inhibitors) or gliptins.
It's used to treat type 2 diabetes, which is caused by problems with a hormone in your body called insulin.
Gliptins help your body make more insulin. They also stop your body releasing too much sugar (glucose) into your blood.
Both of these things help keep your blood sugar levels stable.
How long does it take to work?
Saxagliptin starts to work within a few hours.
You need to take it every day to make sure your blood sugar stays as stable as possible.
How long will I take saxagliptin for? Can I come off it?
Saxagliptin helps keep your blood sugar level as normal as possible to prevent health problems.
You'll probably have to take it for a long time, even for the rest of your life.
Over time it gets harder to control blood sugar levels, so your doctor might eventually recommend stopping saxagliptin and trying a different treatment.
Do not stop taking saxagliptin without speaking to your doctor.
Does it cause hypoglycaemia ('hypos')?
Saxagliptin does not usually cause low blood sugar (known as hypoglycaemia, or "hypos") when taken on its own.
If you're taking other medicines for diabetes, your doctor may recommend reducing the dose of your other medicines when you start saxagliptin. This will reduce the risk of hypos.
Is it safe to take long-term?
Saxagliptin is safe to take for a long time.
There do not seem to be any lasting harmful effects from taking it for many months or even years.
Are there similar medicines to saxagliptin?
Saxagliptin is a dipeptidylpeptidase-4 inhibitor (DPP-4 inhibitor). Similar medicines include alogliptin, linagliptin, sitagliptin and vildagliptin.
There are other diabetes medicines that you swallow, such as metformin, gliclazide, glimepiride, pioglitazone, canagliflozin, dapagliflozin and empagliflozin.
Are there different types of diabetes medicines?
There are several medicines that can lower blood sugar levels:
- sulphonylureas, like gliclazide
- DPP-4 inhibitors, like saxagliptin
- SGLT2 inhibitors, like dapagliflozin
- GLP-1 agonists, like exenatide (given by injection)
- insulin (given by injection)
Your doctor might recommend taking more than one type of diabetes medicine at the same time.
Can I get diabetes medicines for free?
Can I take saxagliptin before surgery?
Yes, you can take saxagliptin before surgery.
Tell your surgeon that you're taking saxagliptin and any other medicines.
Will it affect my fertility?
There's no firm evidence to suggest that taking saxagliptin will reduce fertility in either men or women.
But speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking saxagliptin.
But it's best to drink no more than 2 units per day. Drinking more than this can increase your risk of low blood sugar.
Try to keep to the recommended guidelines of no more than 14 units of alcohol a week.
A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Is there any food or drink I need to avoid?
It's a good idea to cut down on foods with added sugar.
Check the nutrition labels as many foods and drinks are high in sugar, such as:
- some fizzy drinks
- juice drinks
Will it make me lose weight?
Saxagliptin does not usually make people lose weight or put on any weight.
Can I drive or ride a bike?
If your blood sugar levels are stable, taking saxagliptin should not affect your ability to drive, cycle or use machinery and tools.
If your blood sugar levels become too low, this can reduce your concentration.
If this happens to you, do not drive, cycle or use machines or tools until you feel better.
Can lifestyle changes help?
There are some lifestyle changes you can make to help control the symptoms of diabetes.
- eating a healthy diet
- losing any excess weight
- not smoking
- cutting down on alcohol - try to stick to no more than 2 units a day. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
- exercising - up to 30 minutes a day, 5 times a week is ideal
Saxagliptin is usually prescribed when diet and exercise alone have not been enough to control your blood sugar levels.