Uses

A combination of saxagliptin (DPP-4 inhibitor) and metformin (biguanide) indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Do not use if

Contraindicated in patients with severe renal impairment (eGFR below 30 mL/min/1.73 m²), acute or chronic metabolic acidosis including diabetic ketoacidosis, and history of serious hypersensitivity to saxagliptin or metformin.

Side effects

Common adverse reactions include upper respiratory tract infection, urinary tract infection, and nasopharyngitis. Serious risks include lactic acidosis (metformin), pancreatitis (saxagliptin), heart failure hospitalization, and hypoglycemia when combined with insulin secretagogues. Vitamin B12 deficiency may occur with long-term metformin use.

Warnings

Boxed warning: metformin-associated lactic acidosis can be fatal; risk increases with renal impairment, hepatic impairment, congestive heart failure, and excessive alcohol intake. Hold metformin before iodinated contrast procedures. Monitor renal function regularly. Saxagliptin has been associated with an increased risk of heart failure hospitalization.

How it works

Saxagliptin inhibits the enzyme DPP-4, thereby increasing active incretin hormone (GLP-1 and GIP) concentrations, which stimulate glucose-dependent insulin release and suppress glucagon. Metformin decreases hepatic glucose production, reduces intestinal glucose absorption, and improves peripheral insulin sensitivity.

Storage

Store at room temperature, 20°C to 25°C. Protect from moisture.