Dr K. here, your virtual pharmacist.  The last time we spoke, I talked about the DPP-4 inhibitor Januvia.  When I was first learning about all of the type 2 diabetes medications in college, Januvia was the only medication in this category.  But things in medicine, as in life, are always changing, right?  In 2009 a second DPP-4 inhibitor was approved by the Food and Drug Administration for use in the US.  It is not available as a generic yet; it is known by the brand name Onglyza.  Once the patent expires and it becomes a generic, it will be known as saxagliptin.

How does it lower blood sugar: Just like the other DPP-4 inhibitor we’ve talked about (Januvia), Onglyza lowers blood sugars after you eat.  Without going into too many pesky details, I’ll tell you that Onglyza helps your body to produce more insulin in response to the sugars in the food you eat.  Remember, insulin is the substance in your body that helps move sugars (glucose) from your blood and into your cells, where they belong.

Onglyza also helps by decreasing the amount of glucagon that your body is making.  As a review, glucagon is a chemical that does the exact opposite of insulin – it put glucose back into your blood.  Sometimes this is necessary; glucose is energy for your body, so glucagon helps the glucose move from where it is being stored to areas where it is needed (your brain, your muscles when you are exercising, etc).  But in diabetics, sometimes this pushes too much glucose into your blood, which is not good.  So Onglyza helps to make sure your blood sugar levels stay in their healthy range.

The effect on your numbers: When used alone, Onglyza may lower your A1c by 0.5-0.6% (example, an A1c of 9.6 could go down to 9.0 to 9.1).  It has been shown to lower fasting glucose numbers by an average of 15 mg/dL and by an average of 45 mg/dL two hours after eating.  Onglyza works very well when added to other diabetes medications also, such as metformin and insulin.  Onglyza does not affect most people’s weight (no weight gain!).

Dosing: Doses of Onglyza can be 2.5 or 5 mg taken once daily, with or without food.  The pills should not be chewed, split, or crushed.

Side effects: Possible side effects include peripheral edema (fluid buildup and swelling in the legs, hands, or feet), low blood sugar (especially if you are also taking insulin, glyburide, glipizide, or glimepiride), headache, upper respiratory tract infection, or urinary tract infection.

Onglyza may also cause inflammation of the pancreas, known as pancreatitis.  This is rare, but can be severe and lead to death.  Stop taking Onglyza right away and call your doctor if you have stomach or abdominal pain that does not go away.  You may or may not experience nausea and vomiting with this pain.

Who should not take Onglyza: Onglyza has not been studied in children under 18.  There are also no adequate studies on Onglyza use during pregnancy or breastfeeding, so caution should be used if considering this medication.  If you have reacted badly to Januvia, Onglyza might not be the right medication for you, since they work in a similar way.  Patients with severe kidney disease may be able to take Onglyza, but the dose might need to be lowered.  Since Onglyza may cause pancreatitis, it might not be the best option for patients with a history of pancreatitis.  Onglyza will not be effective for Type 1 diabetics.

Drug interactions: Onglyza can interact with certain HIV medications and antibiotics, so make sure that your doctor and pharmacist are aware of all medications you are taking before starting Onglyza.  Also, since the diabetic meds Avandia and Actos can cause fluid retention (as does Onglyza), it is not recommended that they are used with Onglyza.

Monitoring: As always, you should be monitoring your blood sugars daily when on Onglyza.  Watch for the signs of edema and pancreatitis that I have mentioned above.  Your doctor will also be monitoring your A1c and any other lab values needed to see how well you are fight back against diabetes.

Place in therapy for diabetes: Due to the price, the relative newness of the medication, and the fact that it does not lower A1c as much as some of the other medications available, Onglyza is not usually the first option for most diabetic patients.  But, if high blood sugars after a meal are a big concern, your doctor might try using Onglyza on its own, or adding it to your other diabetes medications.

If you would like to learn more about Onglyza you can visit the official website here.

As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions.  However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs.  Remember to always check with your medical provider and pharmacist before stopping or starting any new medications.  My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health.  Please consult with your doctor and pharmacist about anything regarding your health.

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