Saxagliptin

How it works

By inhibiting DPP-4 it prolongs the activity of incretin hormones, increasing glucose-dependent insulin secretion and suppressing glucagon, thereby lowering blood glucose.

Prescribing in practice

• DPP-4 inhibitors including saxagliptin have been associated with acute pancreatitis, so treatment should be stopped if pancreatitis is suspected.
• A signal for increased heart-failure hospitalisation was observed in cardiovascular outcome data, so caution is advised in patients with heart failure risk factors.
• Dose adjustment is required in renal impairment, and rare hypersensitivity reactions including angioedema have been reported.

Monitoring

Monitor glycaemic control with HbA1c and assess renal function periodically to guide continued dosing.

Counselling the patient

• Report severe, persistent abdominal pain, which could indicate pancreatitis.
• Report worsening breathlessness or swelling, which may suggest heart failure.
• Hypoglycaemia is uncommon alone but more likely if combined with insulin or a sulfonylurea.

Evidence & guidelines

The SAVOR-TIMI 53 trial confirmed glycaemic efficacy and characterised the heart-failure hospitalisation signal, consistent with the SPC.