Saxagliptin (Onglyza) for type 2 diabetes
Published in Medicine Update
Date published: About this date
This Medicine Update is for people who are taking, or thinking about taking, saxagliptin.
Saxagliptin (brand name Onglyza) is a tablet that can be used by people with type 2 diabetes whose blood glucose levels cannot be controlled effectively with certain other medicines.
If you are prescribed saxagliptin, you will take it in addition to your existing diabetes medicine. Saxagliptin, taken with your other medicine, can help better control blood glucose. Controlling blood glucose levels is important to help you to avoid the long-term complications of diabetes.
Saxagliptin has been tested in clinical trials and has been shown to be effective in helping to lower blood glucose levels. Because it is a new medicine, it is not yet known if it reduces the long-term complications of diabetes.
- What saxagliptin is
- What saxagliptin is for
- Who can take saxagliptin
- How to take saxagliptin
- What does saxagliptin do?
- Important side effects of saxagliptin to consider
- What else you should know about saxagliptin
- Other medicines available for type 2 diabetes
- How to decide between saxagliptin and other medicines
- What does saxagliptin cost?
- Other ways to help type 2 diabetes
- Where to find more information
The active ingredient of this medicine is saxagliptin (pronounced SAX-ah-GLIP-tin). It is also known by the brand name Onglyza.
Saxagliptin is a medicine to help control blood glucose in people with type 2 diabetes.
Saxagliptin treats type 2 diabetes by helping to control blood glucose levels.
People with type 2 diabetes have too much glucose in their blood because their body does not produce enough insulin or their insulin doesn’t work properly (called insulin resistance).
Having high blood glucose levels increases your risk of developing the long-term complications of diabetes.
People with diabetes may develop heart disease, kidney disease, eye disease, pain or loss of feeling and poor circulation in the feet and problems with sexual function. These complications are serious.
Saxagliptin is available on the Pharmaceutical Benefits Scheme (PBS) for people with type 2 diabetes, but there are some restrictions on its use. In general terms, you can get saxagliptin through the PBS if:
- you are already taking metformin (e.g. Diabex, Diaformin) or a sulfonylurea (e.g. Amaryl, Daonil, Diamicron, Minidiab), and
- your HbA1c (a measurement of your average blood glucose levels over the last 10–12 weeks) is over 7%, and
- you cannot use a combination of metformin and a sulfonylurea, or the combination causes you intolerable side effects.
Please note — saxagliptin is not taken on its own. You will need to continue taking your metformin or sulfonylurea when you start saxagliptin and you should continue to follow dietary and other lifestyle advice (see Other ways to help type 2 diabetes).
Speak to your doctor if you have kidney problems. Saxagliptin is removed from your body by the kidneys so if you have serious kidney problems the medicine can build up in your blood. You may still be able to take saxagliptin, but your doctor will have to take this into account before prescribing.
Take one saxagliptin tablet at approximately the same time each day. Taking your tablets at the same time each day will have the best effect and it will also help you remember when to take the tablets.
You can take saxagliptin tablets with or without food. Swallow the tablets whole with a glass of water.
Saxagliptin reduces glucose levels in the blood. It does this by:
- increasing the amount of insulin in the blood
- reducing the amount of glucose produced by the liver.
It is not yet known if saxagliptin reduces the long-term complications of diabetes (see How to decide between saxagliptin and other medicines).
Ask your health professional about the possible side effects of this medicine before you take it. Always tell them about any changes to your condition if you're taking a new medicine.
To report possible side effects call the NPS Adverse Medicine Events (AME) line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).
People with questions about their medicines or seeking general information about side effects can call the NPS Medicines Line on 1300 633 424 (Monday–Friday, 9am–5pm AEST).
The most common side effects of saxagliptin are headache and cold-like symptoms.
Some rare but serious side effects can occur with saxagliptin, such as:
- allergic reactions
- increased risk of bone fractures
- pancreatitis (inflammation of the pancreas that can result in severe, long-lasting abdominal pain).
Allergic reactions are rare, but you should seek medical attention if you have any swelling of the face, mouth, tongue or throat.
Pancreatitis has developed in a small number of people after starting the closely related medicines sitagliptin (Januvia) and vildagliptin (Galvus). It’s not known for sure if these medicines caused the pancreatitis.
Saxagliptin has been tested in clinical trials, but it is still quite a new medicine so the full range of side effects is not yet known. You should be aware of this and talk to your doctor if you have any concerns.
For a more complete list of possible side effects for Onglyza (saxagliptin), see the consumer medicine information (CMI) leaflet available on our Medicines search page.
Some other medicines can interact with saxagliptin.
You should tell your doctor about all the medicines you take, including any you get from a pharmacy, supermarket or health food store.
Use a medicines list to help keep track of the medicines you are taking. Take it with you each time you visit a health professional, or if you go into hospital.
Most people start taking medicines when lifestyle changes, diet and exercise are not sufficient to manage their diabetes.
Your medicine options will depend on your blood glucose control, your response (including side effects), your age and health, and other medicines that you are taking.
The medicines you take for your diabetes may change over time. For example, you might only need a single tablet — like metformin or a sulfonylurea — to control your blood glucose level initially. But diabetes tends to get worse as you get older and at some point your doctor may recommend that you take more than one type of tablet or that you take insulin, or a combination of both. Each medicine will work in a different way to help control your blood glucose level.
The other types of medicine you might take are:
- acarbose and repaglinide.
Sitagliptin (Januvia) and vildagliptin (Galvus) are other medicines you may be asked to consider. They belong to the same group of medicines as saxagliptin. Read more about sitagliptin and vildagliptin.
Metformin (e.g. Diabex, Diaformin) is the first tablet most people take for type 2 diabetes. It makes your own insulin more effective and reduces the amount of glucose produced by your liver.
Metformin may cause nausea, loss of appetite, weight loss and diarrhoea.
Sulfonylureas are often added to metformin. They may also be used as the first tablet by people who cannot take metformin. Sulfonylureas increase your body’s production of insulin.
The sulfonylureas include glibenclamide (e.g. Daonil), gliclazide (e.g. Diamicron), glimepiride (e.g. Amaryl, Dimirel) and glipizide (e.g. Minidiab).
Many people taking sulfonylureas gain weight and may have hypoglycaemic episodes (when blood glucose levels drop below normal). Allergic reactions may occur.
Pioglitazone (Actos) and rosiglitazone (Avandia) are relatively new medicines for type 2 diabetes. Like saxagliptin, pioglitazone and rosiglitazone can be taken with metformin or a sulfonylurea. Glitazones make your own insulin more effective.
Glitazones can cause fluid retention and weight gain, and increase the risk of some bone fractures in women.
Glitazones are not suitable for people with heart failure. Rosiglitazone should not be used by people with heart disease.
Exenatide (Byetta) is a new injectable medicine, but it is not insulin. It is used in addition to tablets to help reduce blood glucose levels.
Some people feel nauseous when they start using exenatide. People using exenatide can have hypoglycaemic episodes (low blood glucose levels), particularly if they are also taking a sulfonylurea.
If you can no longer make enough of your own insulin, tablets such as metformin and sulfonylureas will not work properly on their own. At this point your doctor might suggest that you start using insulin to control your blood glucose level.Insulin can be used on its own or with some other medicines for type 2 diabetes. Saxagliptin is not usually used with insulin.
Insulin is injected — usually once, twice or three times a day. While many people worry about injecting insulin, most find the injections are not painful.
The main side effects of insulin are weight gain and hypoglycaemia (low blood glucose levels). Allergic reactions are possible and some people get skin reactions at the site of injections.
Acarbose and repaglinide
Acarbose (Glucobay) and repaglinide (Novonorm) are used by a small number of people for whom other medicines are unsuitable.
Read more about type 2 diabetes including information on other medicines and non-drug treatments.
Remember that benefits and side effects differ between medicines and from person to person.
A medicine that suits one person may not suit another. You may wish to avoid certain side effects or, if the medicine is working well, you may be willing to put up with the possible side effects. Talk to your doctor about what's best for you.
There are two main reasons to treat your diabetes:
- to keep your blood glucose levels within normal levels
- to reduce your risk of developing the longer term complications of diabetes.
Like all medicines used for type 2 diabetes, saxagliptin reduces the level of glucose in the blood.
But it is not known if it can reduce your risk of developing the long-term complications of diabetes. This will only become clear when saxagliptin has been used by more people for longer periods of time.
Insulin, metformin and sulfonylureas have been shown to reduce the long-term complications of diabetes. This is a very important benefit of these medicines.
Weight gain and hypoglycaemia
Most medicines for type 2 diabetes — except metformin — can sometimes cause hypoglycaemia. Hypoglycaemia is more likely to occur with insulin or sulfonylureas than with other tablets.
Saxagliptin does not appear to increase the risk of hypoglycaemia when taken with metformin. Nor does it cause weight gain. However, hypoglycaemia and weight gain may still occur if saxagliptin is used with a sulfonylurea.
Cost to the Government
The full cost of saxagliptin to the Australian Government is:
- $91.19 for 5 mg saxagliptin tablets (pack size 28 tablets).
Each prescription lasts 28 days and you can get up to 5 repeats.
Cost to the individual
If you get saxagliptin through the Pharmaceutical Benefits Scheme (PBS), the Australian Government pays most of the cost and you will pay only a part, called the co-payment.
At the time of publication the co-payment for people who are entitled to get saxagliptin through the PBS is:
- $34.20 for people without a concession card
- $5.60 for concession card holders.
If you’re not eligible to get saxagliptin through the PBS, you will need to pay the full price for a prescription.
A healthy lifestyle is important for all people with diabetes. A dietitian, diabetes educator or doctor can help you with this.
Regular physical activity is important for managing diabetes. Many people find that their diabetes is easier to manage with regular physical activity (e.g. 30 minutes of physical activity on 5 or more days per week). Resistance training (e.g. using light weights) is recommended, as is aerobic exercise (e.g. walking or cycling). A diabetes educator, exercise physiologist or doctor can help you with this.
If you have just been diagnosed with type 2 diabetes your doctor will usually recommend that you eat a healthy, balanced diet and exercise regularly for 3 months to see if this controls your diabetes without the need for medication (unless the symptoms of diabetes are severe).
Even when using medicines, you should continue to follow a healthy, balanced diet and carry out regular exercise. This can help you to maintain a healthy weight. It may also improve your blood glucose control, reduce your need for medicines and help to prevent some of the long-term complications of diabetes.
Monitoring your glucose
Monitoring your own blood glucose levels regularly can help you to manage your diabetes. Speak to your diabetes educator or doctor.
If you smoke you should make every effort to quit. The combination of smoking and diabetes greatly increases the risk of heart disease and other complications of diabetes. Quitting smoking will also have a positive impact on your health and substantially reduce your risk of other illnesses.
If you drink alcohol, then a low-to-moderate intake is best (e.g. no more than 2 standard drinks per day for women and 3 standard drinks per day for men). You should discuss this with your health professional.
Alcohol can interact with some diabetes medicines and make hypoglycaemia more likely.
If you have diabetes and high blood pressure it’s important that you work with your doctor to keep your blood pressure under control. Studies have shown that good blood pressure control can prevent some of the long-term complications of diabetes.
For more information, contact Diabetes Australia on 1300 136 588.
Where to find more information
You can find more information in the consumer medicine information (CMI). This will tell you:
- who should not use the medicine
- which other medicines should be avoided
- how to take the medicine
- most of the possible side effects
- the ingredients.
You can get the CMI leaflet for Onglyza from:
- your doctor or pharmacist
- our Medicines search page
- Bristol-Myers Squibb, the makers of Onglyza (saxagliptin), on 1800 067 567.
Information over the phone
NPS works with healthdirect Australia to provide the Medicines Line phone service for consumers.
To get more information about any medicine call 1300 MEDICINE (1300 633 424). This service is available from anywhere in Australia, Monday to Friday, 9am to 5pm AEST excluding NSW public holidays.
To report a side effect
Call the NPS Adverse Medicine Events (AME) Line on 1300 134 237, Monday to Friday, 9am to 5pm AEST excluding public holidays.
The AME Line is a service where you can report possible side effects of your medicine and contribute to national medicine safety efforts. Information on medicine-related side effects is passed on to the Therapeutic Goods Administration (TGA) for assessment, but your personal details will remain confidential and your privacy maintained.