Saxagliptin with metformin

How it works

Saxagliptin raises incretin hormone levels to enhance glucose-dependent insulin release and lower glucagon, while metformin reduces hepatic glucose production and improves peripheral insulin sensitivity.

Prescribing in practice

• The metformin component requires renal function review and temporary withholding during acute illness, dehydration, or before procedures with iodinated contrast, because of the rare risk of lactic acidosis.
• Saxagliptin may rarely cause acute pancreatitis and hypersensitivity; stop if pancreatitis is suspected, and exercise caution in heart failure.
• Metformin commonly causes gastrointestinal upset, mitigated by taking with food and using a modified-release formulation if needed.

Monitoring

Monitor renal function and HbA1c, and review for gastrointestinal tolerance and signs of pancreatitis.

Counselling the patient

• Take with or after food to reduce stomach upset.
• Stop the tablet and seek advice during severe illness, dehydration, or before a scan using contrast dye.
• Report severe, persistent abdominal pain promptly.

Evidence & guidelines

Metformin remains the established first-line agent for type 2 diabetes in NICE guidance, with DPP-4 inhibitors added as recognised second-line intensification options.