Onglyza (saxagliptin) is a prescription medication belonging to the dipeptidyl peptidase-4 (DPP-4) inhibitor class, specifically designed to improve glycemic control in adults with type 2 diabetes mellitus. It functions by enhancing the body’s innate ability to lower high blood sugar levels by increasing the release of insulin after meals and decreasing the amount of sugar produced by the liver. This oral therapy is commonly used in conjunction with diet and exercise, and can be prescribed as a monotherapy or in combination with other antidiabetic agents such as metformin, sulfonylureas, or thiazolidinediones when needed. Its targeted mechanism offers a glucose-dependent action, which may help reduce the risk of hypoglycemia when not used with insulin secretagogues.

Features

• Active ingredient: Saxagliptin
• Drug class: Dipeptidyl peptidase-4 (DPP-4) inhibitor
• Available as film-coated tablets in 2.5 mg and 5 mg strengths
• Once-daily oral administration, with or without food
• Not indicated for type 1 diabetes or diabetic ketoacidosis

Benefits

• Effectively lowers hemoglobin A1c (HbA1c) levels as part of a comprehensive diabetes management plan.
• Works in a glucose-dependent manner, reducing the risk of hypoglycemia when used without sulfonylureas or insulin.
• Supports pancreatic beta-cell function by increasing insulin secretion and suppressing glucagon release.
• Convenient once-daily dosing supports adherence to long-term treatment regimens.
• Can be used as both monotherapy and in combination with other antidiabetic medications for tailored treatment.
• Does not typically cause weight gain, a common concern with some other diabetes therapies.

Common use

Onglyza is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is often prescribed when lifestyle modifications alone are insufficient to achieve target blood glucose levels. Clinicians may use it as a standalone treatment or combine it with other oral antidiabetic drugs like metformin, a sulfonylurea, or a thiazolidinedione to address multifactorial pathophysiological defects in type 2 diabetes. It is not suitable for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

Dosage and direction

The recommended dosage of Onglyza is 5 mg taken orally once daily, with or without food. For patients with moderate to severe renal impairment (creatinine clearance ≤50 mL/min) or those with end-stage renal disease requiring hemodialysis, the dose should be reduced to 2.5 mg once daily. Hemodialysis may remove a small amount of saxagliptin; therefore, administration should occur after dialysis on dialysis days. No dosage adjustment is required for patients with hepatic impairment. The tablet should be swallowed whole and not crushed, split, or chewed.

Precautions

Before initiating Onglyza, assess renal function since dosage adjustment is necessary in renal impairment. Use caution when co-administering with strong CYP3A4/5 inhibitors (e.g., ketoconazole), as this may increase saxagliptin exposure. Monitor for signs and symptoms of pancreatitis; if suspected, discontinue promptly. There have been postmarketing reports of severe and disabling arthralgia; consider discontinuation if severe joint pain occurs. Use during pregnancy only if clearly needed, as there are limited data in pregnant women. It is unknown if saxagliptin is excreted in human milk; caution is advised when administering to nursing women. Not recommended for use in pediatric patients.

Contraindications

Onglyza is contraindicated in patients with a history of serious hypersensitivity reaction to saxagliptin or any component of the formulation, including anaphylaxis, angioedema, or severe skin reactions. It should not be used for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis.

Possible side effect

Common adverse reactions (≥5%) include upper respiratory tract infection, urinary tract infection, and headache. Hypoglycemia may occur when used with a sulfonylurea. Less common but serious side effects can include pancreatitis, heart failure (especially in patients with a history of heart or kidney disease), severe joint pain, and hypersensitivity reactions such as anaphylaxis, angioedema, or exfoliative skin conditions. Elevated lymphocyte counts and reduced absolute neutrophil counts have been observed. Patients should report any unusual symptoms, such as persistent abdominal pain, signs of heart failure (e.g., shortness of breath, swelling), or skin rashes, to their healthcare provider immediately.

Drug interaction

Strong CYP3A4/5 inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin) can increase saxagliptin plasma concentrations; limit Onglyza dose to 2.5 mg once daily when co-administered. Inducers of CYP3A4/5 (e.g., rifampin) may decrease saxagliptin concentrations. No clinically significant interactions were observed with metformin, glyburide, pioglitazone, diltiazem, simvastatin, or omeprazole. As with all antidiabetic therapies, monitor blood glucose when adding or discontinuing drugs that may affect glycemic control (e.g., corticosteroids, thyroid products).

Missed dose

If a dose of Onglyza is missed, it should be taken as soon as remembered on the same day. If missed entirely, the patient should take the next dose at the regular time the following day. Do not double the dose to make up for a missed one. Maintaining a consistent dosing schedule is important for optimal glycemic control.

Overdose

In the event of an overdose, supportive measures are recommended, including removal of unabsorbed material from the gastrointestinal tract, clinical monitoring, and supportive treatment as necessary. Saxagliptin is modestly dialyzable (23% removed over a 4-hour session); hemodialysis may be considered in cases of significant overdose. There is no specific antidote for saxagliptin overdose. Contact a poison control center or healthcare provider for further management guidance.

Storage

Store Onglyza tablets at room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the bottle tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the bottle.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any medical condition or treatment plan. Individual patient responses may vary. Only a licensed healthcare professional can determine the appropriate use of Onglyza based on a patient’s specific health profile.

Reviews

Clinical trials and postmarketing surveillance have demonstrated Onglyza’s efficacy in reducing HbA1c with a generally favorable tolerability profile. Many endocrinologists value its once-daily dosing and lower risk of hypoglycemia as part of a combination regimen. Some real-world evidence notes its utility in patients who do not tolerate metformin or require add-on therapy. However, prescribers remain vigilant regarding rare but serious adverse effects such as pancreatitis and heart failure, particularly in at-risk populations. Patient-reported outcomes often highlight convenience and minimal impact on daily life, though experiences with side effects vary.