Saxagliptin with dapagliflozin

How it works

Saxagliptin increases incretin levels to enhance glucose-dependent insulin secretion and suppress glucagon, while dapagliflozin blocks renal glucose reabsorption in the proximal tubule to promote urinary glucose excretion.

Prescribing in practice

• Counsel on diabetic ketoacidosis, which can occur with dapagliflozin even with near-normal glucose; advise withholding during acute illness, dehydration or before major surgery (sick-day rules).
• The dapagliflozin component predisposes to genital and urinary infections and volume depletion, and efficacy depends on renal function which must be assessed before and during treatment.
• Saxagliptin carries a small risk of acute pancreatitis and rare hypersensitivity; discontinue if pancreatitis is suspected.

Monitoring

Monitor renal function, glycaemic control (HbA1c), volume status and for signs of ketoacidosis or genitourinary infection.

Counselling the patient

• Stop the tablet and seek urgent help if you feel very unwell with nausea, vomiting, abdominal pain or rapid breathing, as this can signal ketoacidosis.
• Maintain good genital hygiene and report symptoms of thrush or urinary infection.
• Pause this medicine if you cannot eat or drink normally and contact your team for advice.

Evidence & guidelines

MHRA has warned that SGLT2 inhibitors such as dapagliflozin can cause life-threatening diabetic ketoacidosis, sometimes with only modestly raised blood glucose.