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Onglyza Januvia Comparison

What Everyone With Type 2 Diabetes Should Know

What Everyone With Type 2 Diabetes Should Know

Nearly 20 million Americans have type 2 diabetes, also known as adult-onset diabetes, a condition where a person’s body does not respond well to sugar or store it properly. Diabetes can cause many very serious health problems, including kidney disease, blindness, amputation and, most notably, heart disease. Diabetes can even increase your risk of developing cancer. These health problems that are caused by diabetes are more dangerous than the diabetes itself. Diabetes is becoming more and more common, and is estimated to affect more than 9% of the U.S. population in 2014.[1] The fact that people often take diabetes medication for many years, has meant that a diabetes drug can make a lot of money for a pharmaceutical company. As a result, many drugs to treat diabetes have come on the market in the last several years. But unfortunately, it’s not clear if the new drugs are better than the old ones – in fact, all the newer drugs have serious safety concerns (see below for more details). There is also uncertainty about the best way to treat diabetes, especially among older adults. Recent studies suggest that using drugs to keep blood sugar very tightly controlled in type 2 diabetes patients, especially older adults, may not always be beneficial. If blood sugar gets too low, this can cause serious health problems in older adults. And the benefits of tight blood sugar control are likely to only help younger people. In other words, older adults may be less likely to benefit, and more likely to be harmed, by the traditional guidelines for blood sugar (glucose). Medical experts are now starting to change their recommendations by relaxing blood sugar level goals for older adults. New Warnings about Drugs Containing Saxagliptin and Alogliptin In April 2016, the FDA issued a wa Continue reading >>

Similarities And Differences Between Onglyza Vs Januvia

Similarities And Differences Between Onglyza Vs Januvia

Similarities and Differences Between Onglyza vs Januvia Similarities and Differences Between Onglyza vs Januvia Both onglyza and januvia are oral diabetes drugs that belong to a class of drugs known as DPP-4 or dipeptidyl peptidase-4. This class of drugs is used to control high blood sugar levels in people with type 2 diabetes (T2D) .T2D refers to a chronic medical condition where the body does not produce enough insulin or use it properly. Insulin is a hormone which is produced by the beta cells in the pancreas. This naturally occurring hormone works by helping glucose get into the bodys cells to be used for energy. Without insulin, glucose cannot enter the bodys cells, thus they stay in the bloodstream. Too much glucose in the bloodstream can lead to serious health complications such as nerve and kidney damage. To prevent these long term health complications, your doctor may prescribethese medications to people with T2D. DPP-4 inhibitors such as onglyza and januvia work by blocking the action of an enzyme called DPP-4, which destroys incretin. Incretin is a natural hormone that helps the body produce more insulin in case of high blood sugar levels. Incretin also works by reducing the amount of glucose that is produced by the liver. As a result, takingthese meds can help reduce high blood sugar levels in people with T2D. Onglyza is a diabetes drug that is used to control high blood glucose levels in people with T2D. You should take this medication as it is prescribed by your doctor. Your dosage is based on your medical condition and response to treatment. Your doctor may need to change your dose so that you can achieve the best results with this medication. Saxagliptin is the active ingredient in this medication, and is only part of a treatment program which also incl Continue reading >>

Best Treatments For Type 2 Diabetes

Best Treatments For Type 2 Diabetes

At-a-glance Six classes of oral medicines (and 12 individual drugs) are now available to help the 25.8 million people in the U.S. with type 2 diabetes control their blood sugar when diet and lifestyle changes are not enough. Our evaluation of these medicines found the following: Newer drugs are no better. Two drugs from a class called the sulfonylureas and a drug named metformin have been around for more than a decade and work just as well as newer medicines. Indeed, several of the newer drugs, such as Januvia and Onglyza, are less effective than the older medications. Newer drugs are no safer. All diabetes pills have the potential to cause adverse effects, both minor and serious. The drugs’ safety and side effect “profiles” may be the most important factor in your choice. The newer drugs are more expensive. The newer diabetes medicines cost many times more than the older drugs. Taking more than one diabetes drug is often necessary. Many people with diabetes do not get enough blood sugar control from one medicine. Two or more may be necessary. However, taking more than one diabetes drug raises the risk of adverse effects and increases costs. Taking effectiveness, safety, adverse effects, dosing, and cost into consideration, we have chosen the following as Consumer Reports Best Buy Drugs if your doctor and you have decided that you need medicine to control your diabetes: Metformin and Metformin Sustained-Release — alone or with glipizide or glimepiride Glipizide and Glipizide Sustained-Release — alone or with metformin Glimepiride — alone or with metformin These medicines are available as low-cost generics, costing from $4 to $35 a month. If you have been diagnosed with diabetes, we recommend that you try metformin first unless it's inappropriate for your hea Continue reading >>

18-week Add-on To Metformin Comparison Of Saxagliptin And Sitagliptin In Adult Patients With Type 2 Diabetes (t2d)

18-week Add-on To Metformin Comparison Of Saxagliptin And Sitagliptin In Adult Patients With Type 2 Diabetes (t2d)

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. 18-week add-on to Metformin Comparison of Saxagliptin and Sitagliptin in Adult Patients With Type 2 Diabetes (T2D) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00666458 Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Saxagliptin is a new investigational medication being developed for treatment of type 2 diabetes. This study is designed to assess the efficacy and tolerability of saxagliptin in addition to metformin and compare to sitagliptin in addition with metformin. Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) 18-wk, International, Multi-centre, Randomized, Parallel-group, Double-Blind, Active-Controlled Phase IIIb Study to Evaluate the Efficacy and Safety of Saxagliptin in Combination With Metformin in Comparison With Sitagliptin in Combination With Metformin in Adult Patients With T2D Who Have Inadequate Glycaemic Control on Metformin Alone Hemoglobin A1c (HbA1c) Change From Baseline to Week 18 [TimeFrame:Baseline, Week 18] Adjusted mean change from baseline in HbA1c achieved with saxagliptin added on to metformin versus sitagliptin added on to metformin at Week 18 (Per Protocol Analysis Set). HbA1c is a continuous measure, the change from baseline for each participant is calculated as the Week 18 value minus the baseline value. Proportion of Patients Achieving Therapeutic Glycaemic Response Defined as HbA1c <= 6.5% at Continue reading >>

Comparison Of Charges And Resource Use Associated With Saxagliptin And Sitagliptin

Comparison Of Charges And Resource Use Associated With Saxagliptin And Sitagliptin

Comparison of charges and resource use associated with saxagliptin and sitagliptin 1 Keyuri Adhikari ,2 Jack Sheehan ,3 and Iftekhar Kalsekar 4 1Health Outcomes and Socioeconomic Sciences, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Health Science Campus, Mail Stop # 1013, 3000 Arlington Ave., Toledo, OH 43614 USA 1Health Outcomes and Socioeconomic Sciences, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Health Science Campus, Mail Stop # 1013, 3000 Arlington Ave., Toledo, OH 43614 USA 2Novartis Pharmaceuticals, Hyderabad, India 3Health Economics and Outcomes Research, AstraZeneca, Fort Washington, PA 19034 USA 4Health Informatics- Medical Devices, Johnson & Johnson, New York, NY USA Varun Vaidya, Phone: (419) 383-1516, Email: [email protected] . Received 2016 Jan 22; Accepted 2016 Jun 15. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Saxagliptin and sitagliptin are two commonly used dipeptidyl peptidase-4 (DPP-4) inhibitors. Little is known about their comparative effectiveness in the real world, particularly their impact on cost and resources use. The objective of this study was to analyze charges and resource use associated with saxagliptin and sitagliptin to understand the impact of these DPP-4 inhibitor treatment options in a real-world setting. This was a retrospective, new-user study approved by the Institutional Review Board at the University of Toledo. Data were collected from a US insurance c Continue reading >>

Diabetes Treatment: Medications For Type 2 Diabetes

Diabetes Treatment: Medications For Type 2 Diabetes

Healthy lifestyle choices — including diet, exercise and weight control — provide the foundation for managing type 2 diabetes. However, you may need medications to achieve target blood sugar (glucose) levels. Sometimes a single medication is effective. In other cases, a combination of medications works better. The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs — how they're taken, what they do and what side effects they may cause — will help you discuss treatment options with your doctor. Diabetes treatment: Lowering blood sugar Several classes of type 2 diabetes medicines exist. Each class of medicine works in different ways to lower blood sugar. A drug may work by: Stimulating the pancreas to produce and release more insulin Inhibiting the production and release of glucose from the liver Blocking the action of stomach enzymes that break down carbohydrates Improving the sensitivity of cells to insulin Inhibiting the reabsorption of glucose in the kidneys Slowing how quickly food moves through the stomach Each class of medicine has one or more drugs. Some of these drugs are taken orally, while others must be injected. Compare diabetes medications Here's an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doctor about your options and the pros and cons of each. Oral medications Meglitinides Medications Repaglinide (Prandin) Nateglinide (Starlix) Action Stimulate the release of insulin Advantages Work quickly Possible side effects Low blood sugar (hypoglycemia) Weight gain Nausea or vomiting, when interacting with alcohol Sulfonylureas Medications Glipizide (Glucotrol) Glimepiride (Amaryl) Glyburide (DiaBeta, Glynase) Action S Continue reading >>

Dpp-iv Inhibitors

Dpp-iv Inhibitors

Inhibits the degradation of incretins such as GLP-1 by inhibiting the enzyme dipeptidyl peptidase IV (DPP-IV). The incretin effect is prolonged, enhancing glycemic control through various mechanisms, primarily by stimulating insulin synthesis and secretion in a glucose-dependant manner and by reducing glucagon secretion. brand name preparation manufacturer route form dosage^ cost* Januvia sitagliptin phosphate Merck oral tablet 25 mg $885 for 90 tabs oral tablet 50 mg $885 for 90 tabs oral tablet 100 mg $295 for 30 tabs Onglyza saxagliptin Bristol-Myers Squibb oral tablet 2.5 mg $295 for 30 tabs oral tablet 5 mg $885 for 90 tabs Tradjenta linagliptin Eli Lilly oral tablet 5 mg $870 for 90 tabs Janumet sitagliptin phosphate + metformin hydrochloride Merck Sharp & Dohme Corp. oral tablet 50/500 mg $885 for 180 tabs oral tablet 50/1000 mg $885 for 180 tabs Nesina alogliptin Takeda oral tablet 6.25 mg $374 for 30 tabs oral tablet 12.5 mg $374 for 30 tabs oral tablet 25 mg $374 for 30 tabs **Patient Assistant Programs: ** Information gathered by Heather Tran and Gladimir Elysee *Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP). ^Dosage is indicated in mg unless otherwise noted. Continue reading >>

New Fda Warning That Januvia, Onglyza, Tradjenta, And Nesina Are Associated With

New Fda Warning That Januvia, Onglyza, Tradjenta, And Nesina Are Associated With "joint Pain That Can Be Severe And Disabling"

Label Changes About Side Effects For These Type 2 Diabetes Medicines In The Drug Class Called Dipeptidyl Peptidase-4 (DPP-4) Inhibitors In August 2015 the FDA announced that it has found indications of a new side effect for a class of diabetes drugs -- dipeptidyl peptidase-4 (DPP-4) inhibitors -- that includes Januvia, Onglyza, Tradjenta, and Nesina. The FDA found drug adverse event reports of arthralgia, or severe pain in one or more joints, associated with the use of DPP-4 inhibitor diabetes drugs, with Januvia being the one implicated most often, followed by Onglyza. According to the FDA, patients started having symptoms of the new side effect from one day to years after they started taking Januvia, Onglyza, Tradjenta, Nesina or one of the "combination" DPP-4 inhibitors, e.g., Janumet (sitagliptin and metformin). In more detail, the FDA reported that after the DPP-4 inhibitor medicine was discontinued, the patients' symptoms were usually relieved within less than a month of stopping the subject drug. Furthermore, some patients developed severe joint pain again when they restarted the same medicine or another DPP-4 inhibitor. This last fact provides some substantiation for linking this severe joint pain side effect with Januvia, Onglyza, Tradjenta, Nesina, and the other drugs in this DPP-4 inhibitors class. ____________________________________________________ Januvia / Onglyza / Tradjenta / Nesina Free Case Evaluation Strictly Confidential, No Obligation. _____________________________________________________ We get the following more detailed information from the "FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain" document that was issued on August 28, 2015: In a search of the FDA Adverse Event Reporting Sys Continue reading >>

Which Diabetes Drug Is Best?

Which Diabetes Drug Is Best?

TUESDAY, July 19, 2016 -- No single drug to treat type 2 diabetes stands out from the pack when it comes to reducing the risks of heart disease, stroke or premature death, a new research review finds. The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others. Researchers said the results bolster current recommendations to first try an older, cheaper drug -- metformin (Glumetza, Glucophage) -- for most patients with type 2 diabetes. "There are very few things experts agree on, but this is one of them," said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society. "Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes," he said. Metformin can cause upset stomach and diarrhea, so some patients are unable to stick with it day to day, explained Pantalone, who wasn't involved in the study. And people with kidney disease generally shouldn't take it, he said. More than 29 million Americans have diabetes -- mostly type 2, according to the U.S. Centers for Disease Control and Prevention. The disease, which is often linked to obesity, causes blood sugar levels to be chronically high. Over time, that can lead to complications, such as heart disease, stroke, kidney failure and nerve damage, the CDC says. There are numerous classes of medications that lower blood sugar levels. What's been unclear is whether any of those drugs work better than others in warding off diabetes complications and extending people's lives. The new analysis found no obvious winners. But the researchers also cautioned against drawing conclusions: The trials in the review were not specifically designed to see Continue reading >>

Onglyza: Just Like Januvia But With More Serious Side Effects?

Onglyza: Just Like Januvia But With More Serious Side Effects?

NOTE (April 2, 2013): Before you take Onglyza or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE. When the FDA approves a new drug it requires no proof that the drug is more effective than similar, existing drugs, only that it is better than placebo. Which is something to keep in mind as Bristol-Myers Squibb unveils what is sure to be a saturation advertising campaign for its new DPP-4 inhibitor, Onlgyza. This mellifluous moniker is the brand name for Saxagliptin, which alert followers of drug news remember as the Januvia clone developed at the same times as Januvia whose release has been blocked due to its ability to cause "skin lesions" some of which necrotized (i.e. died and fell off) in monkeys. I have read through the Prescribing Information for Onglyza and cannot see any benefit it offers in comparison to Januvia, the other DPP-4 inhibitor currently on the market. Setting aside for the time being the advisability of controlling your blood sugar by turning off a tumor suppressor gene Onglyza offers nothing not offered by Januvia. Both inhibit the expression of the DPP-4 gene for a full 24 hours--which means that if your body was fighting a new, very small DPP-4 sensitive tumor, like ovarian cancer, melanoma, prostate cancer or lung cancer, the drug would keep DPP-4 from killing off the tumor cells. 1. Feeble impact on blood sugar: Onglyza lowered A1cs that averaged 8% by .5%, which does not bring them anywhere near a safe level even by the anemic standards of the ADA. When the highest dose of Onglyza was compared to a placebo, it allowed only 14% more of those taking it to achieve 7% A1cs. To better underst Continue reading >>

Detail-document: Pharmacist's Letter

Detail-document: Pharmacist's Letter

Combining a GLP-1 Agonist and a DPP-4 Inhibitor for Type 2 Diabetes Clinicians are curious about the utility of combining the incretin-based therapies GLP-1 agonists (e.g., exenatide [Byetta, Bydureon-U.S.], liraglutide [Victoza]) and DPP-4 inhibitors (e.g., linagliptin [Tradjenta-U.S., Trajenta-Canada], saxagliptin [Onglyza], sitagliptin [Januvia]). This combination might seem useful for patients who need multiple drugs to manage type 2 diabetes but want to avoid side effects such as weight gain or hypoglycemia with other medications like sulfonylureas or insulin. This document reviews the evidence for using a GLP-1 agonist with a DPP-4 inhibitor in patients with type 2 diabetes. Patients with diabetes have lower levels and impaired action of glucagon-like peptide-1 (GLP-1).1 GLP-1 agonist drugs (incretin mimetics) mimic the action of this incretin hormone. They are structurally similar, but not exactly the same as endogenous GLP-1.2 (Liraglutide is more similar to endogenous GLP-1 than exenatide.) Endogenous GLP-1 is quickly broken down by the enzyme dipeptidyl peptidase-4 (DPP-4). Modification of the structure of these GLP-1 analogs is a strategy to increase the half-life while retaining the physiologic effects of endogenous GLP-1.1 Endogenous GLP-1 is produced in response to food intake. It stimulates glucose-dependent insulin release and suppresses postprandial glucagon secretion. It also delays gastric emptying, which helps increase satiety. GLP-1 agonists not only help reduce A1C by approximately 1% to 1.5%, but they also can help patients lose weight.3,4 DPP-4 inhibitor drugs (gliptins) reduce the breakdown of endogenous GLP-1 by inhibiting the action of DPP-4. DPP-4 rapidly degrades endogenous GLP-1. It has minimal to no effect on GLP-1 agonist drugs. Exenatid Continue reading >>

Saxagliptin - An Overview | Sciencedirect Topics

Saxagliptin - An Overview | Sciencedirect Topics

Thundiparambil Azeez Sonia, Chandra P. Sharma, in Oral Delivery of Insulin , 2014 Saxagliptin was approved by the FDA in July 2009 as a once-daily tablet. It can be taken either as a monotherapy or in combination with hypoglycaemic drugs such as metformin, SUs or thiazolidinediones. A combination of either sitagliptin or vildagliptin with metformin was recently approved; HbA1c is decreased by an additional 0.7% compared with metformin alone [203, 204]. Nowicki et al. reported that once-daily dosage (2.5mg) of saxagliptin is a well-tolerated treatment option for patients with inadequately controlled T2DM and renal impairment [205]. Risks associated with the use of these agents include urinary tract and sinus infections, gastrointestinal disorders, musculoskeletal disorders, hypoglycaemia, fatigue, depression and increased risk of bone fractures. Saxagliptin is metabolized by the cytochrome P450 isoenzyme CYP 3A4; hence it carries a higher risk for pharmacokinetic interactions [206]. In view of the above limitations, metformin will be the drug of choice for initial treatment of type 2 diabetes. Incretin mimetics and enhancers may be established as first-line treatment; however, their exact place in therapy remains to be explored. DPP-4 inhibitors could eventually be used in prediabetic stages and in early stages of diabetes in order to prevent the progression of type 2. Since incretin failure may occur early, and can address many pathophysiological features of type 2 diabetes that lead to progression despite use of existing treatments, incretin therapy should be used in early diabetes (prophylactic use). Important issues with regard to practicalities such as oral or parenteral route of administration, long-term safety and efficacy may determine which of the proposed opti Continue reading >>

Sitagliptin

Sitagliptin

Sitagliptin (INN; /sɪtəˈɡlɪptɪn/ ( listen), previously identified as MK-0431 and marketed as the phosphate salt under the trade name Januvia) is an oral antihyperglycemic (antidiabetic drug) of the dipeptidyl peptidase-4 (DPP-4) inhibitor class. It was developed, and is marketed, by Merck & Co. This enzyme-inhibiting drug is used either alone or in combination with other oral antihyperglycemic agents (such as metformin or a thiazolidinedione) for treatment of diabetes mellitus type 2.[2] Adverse effects[edit] Side effects are as common with sitagliptin (whether used alone or with metformin or pioglitazone) as they were with placebo, except for rare nausea and common cold-like symptoms, including photosensitivity.[3] No significant difference exists in the occurrence of hypoglycemia between placebo and sitagliptin.[3][4][5] In those taking sulphonylureas, the risk of low blood sugar is increased.[6] The existence of rare case reports of renal failure and hypersensitivity reactions is noted in the United States prescribing information, but a causative role for sitagliptin has not been established.[7] Several postmarketing reports of pancreatitis (some fatal) have been made in people treated with sitagliptin and other DPP-4 inhibitors,[8] and the U.S. package insert carries a warning to this effect,[9] although the causal link between sitagliptin and pancreatitis has not yet been fully substantiated.[2] One study with lab rats published in 2009 concluded that some of the possible risks of pancreatitis or pancreatic cancer may be reduced when it is used with metformin. However, while DPP-4 inhibitors showed an increase in such risk factors, as of 2009, no increase in pancreatic cancer has been reported in individuals taking DPP-4 inhibitors.[10] The updated (August 20 Continue reading >>

Dpp-4 Inhibitors Charts & Dosing Information For Special Populations

Dpp-4 Inhibitors Charts & Dosing Information For Special Populations

Forms, dosages and dosing considerations for pregnancy, breastfeeding, hepatic and renal. brand name preparation manufacturer route form dosage^ Januvia sitagliptin phosphate (Plus Metformin) Merck oral tablet 25 mg oral tablet 50 mg oral tablet 100 mg Onglyza Saxagliptin (Plus with metformin) Bristol-Myers Squibb oral tablet 2.5 mgD oral tablet 5 mg Tradjenta Linagliptin (Plus with metformin) Eli Lilly oral tablet 5 mg Janumet sitagliptin phosphate + metformin hydrochloride Merck Sharp & Dohme Corp. oral tablet 50/500 mg oral tablet 50/1000 mg Nesina alogliptin Takeda oral tablet 6.25 mg oral tablet 12.5 mg oral tablet 25 mg Dosing (Oral Tablet) Sitagliptin: recommended dose is 25-100 mg once a day. Can be taken with or without food. Saxagliptin: recommended dose is 2.5 or 5 mg once a day. Can be taken with or without food. Linagliptin: recommended dose is 5 mg once a day. Can be taken with or without food. Sitagliptin + metformin: co-formulated as Janumet 50/500 mg twice a day, with meals. Can increase to 50/1000 mg twice a day, with meals (maximum dose). Saxagliptin + metformin XR: co-formulated as Kombiglyze. 2.5/1000 mg, 5/1000 mg, or 5/2000 mg once daily with evening meal. Alogliptin: recommended dose is 25 mg once daily. DPP-4 inhibitors are FDA approved for use as monotherapy in type 2 diabetes (T2DM). DPP-4 inhibitors can also be added to patients already on metformin, sulfonylureas, thiazolidinediones, or insulin. If adding DPP-4 inhibitors to sulfonylurea/insulin therapy, consider decreasing the sulfonylurea/insulin dose, to reduce hypoglycemia risk. DOSING IN SPECIAL POPULATIONS – RENAL Sitagliptin GFR ≥ 50 mL/min, no dosage adjustment needed GFR 30-50 mL/min, do not exceed 50 mg daily GFR < 30 mL/min, do not exceed 25 mg daily For patients on hemodialys Continue reading >>

Steps: Saxagliptin (onglyza) For Type 2 Diabetes Mellitus - American Family Physician

Steps: Saxagliptin (onglyza) For Type 2 Diabetes Mellitus - American Family Physician

2.5 or 5.0 mg once daily; 2.5 mg in patients with moderate to severe renal dysfunction * Estimated retail price of one month's treatment based on information obtained at (accessed May 18, 2010). Few adverse effects have been associated with saxagliptin. Unlike some other oral hypoglycemics, when saxagliptin is used alone it does not increase the likelihood of hypoglycemia. 1 , 3 , 4 When used as monotherapy or add-on therapy with metformin or thiazolidinediones, saxagliptin has an incidence of hypoglycemia that is comparable with placebo. 1 , 3 7 The manufacturer states that hypoglycemia is more common when saxagliptin is combined with glyburide (formerly Micronase), although the frequency is not significantly higher than with glyburide alone (13.3 to 14.6 percent versus 10.1 percent, respectively). 2 , 3 In 0.5 to 1.5 percent of patients, saxagliptin decreases lymphocyte count and causes lymphocytopenia (i.e., lymphocyte count of 750 cells per L [0.75 109 per L] or less). Decreases in lymphocyte count have not caused any clinical sequelae; however, the effects of saxagliptin in patients with preexisting lymphocyte abnormalities (e.g., human immunodeficiency virus infection) are unknown. 3 Patients with moderate to severe renal dysfunction (creatinine clearance of less than 50 mL per minute per 1.73 m2 [0.83 mL per second per m2]) require a dosage reduction to 2.5 mg once daily. The lower dosage also should be used in patients receiving strong cytochrome P450 3A4 and 3A5 inhibitors, such as clarithromycin (Biaxin), ketoconazole, and the antivirals ritonavir (Norvir), nelfinavir (Viracept), and atazanavir (Reyataz). Saxagliptin is U.S. Food and Drug Administration pregnancy category B. 3 Saxagliptin is well tolerated and produces bothersome adverse effects to a similar Continue reading >>

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