saxagliptin and metformin (Oral route)
sax-a-GLIP-tin hye-droe-KLOR-ide, met-FOR-min hye-droe-KLOR-ide
Lactic acidosis is a rare, but serious complication that can occur due to metformin accumulation. The risk of lactic acidosis increases with conditions such as sepsis, dehydration, excessive alcohol intake, hepatic impairment, renal impairment, and acute congestive heart failure. Discontinue therapy and hospitalize the patient immediately for suspected lactic acidosis .
Commonly used brand name(s)
In the U.S.
- Kombiglyze XR
Available Dosage Forms:
- Tablet, Extended Release
Therapeutic Class: Antidiabetic
Pharmacologic Class: Saxagliptin
Chemical Class: Metformin
Uses For saxagliptin and metformin
Saxagliptin and metformin combination is used to treat high blood sugar levels caused by type 2 diabetes. With this type of diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body where it can work properly. Using saxagliptin and metformin will help to lower blood sugar when it is too high and help restore the way you use food to make energy.
Many people can control type 2 diabetes with diet alone or diet and exercise. Following a specially planned diet and exercising will always be important when you have diabetes, even when you are taking medicines. To work properly, the amount of saxagliptin and metformin combination you take must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both, you will want to test your blood sugar to find out if it is too low. Your doctor will teach you what to do if this happens.
Saxagliptin and metformin combination does not help patients who have insulin-dependent or type 1 diabetes, because they cannot produce insulin from their pancreas. Their blood glucose is best controlled by insulin injections.
saxagliptin and metformin is available only with your doctor's prescription.
Before Using saxagliptin and metformin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For saxagliptin and metformin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to saxagliptin and metformin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of saxagliptin and metformin combination in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of saxagliptin and metformin combination in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution for patients receiving saxagliptin and metformin. saxagliptin and metformin is not recommended in patients 80 years of age and older who have kidney problems.
|All Trimesters||B||Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking saxagliptin and metformin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using saxagliptin and metformin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Acetrizoic Acid
- Ethiodized Oil
- Iobenzamic Acid
- Iocarmic Acid
- Iocetamic Acid
- Iodohippuric Acid
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iopanoic Acid
- Iopronic Acid
- Ioseric Acid
- Iotroxic Acid
- Ioxitalamic Acid
- Metrizoic Acid
- Tyropanoate Sodium
Using saxagliptin and metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Eslicarbazepine Acetate
Using saxagliptin and metformin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bitter Melon
- Enalapril Maleate
- Guar Gum
- Methylene Blue
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of saxagliptin and metformin. Make sure you tell your doctor if you have any other medical problems, especially:
- Alcohol, excessive use or
- Underactive adrenal glands or
- Underactive pituitary gland or
- Undernourished condition or
- Weakened physical condition—These conditions could make you more sensitive to the effects of low blood sugar.
- Alcoholism, history of or
- Gallstones or
- Hypertriglyceridemia (high triglycerides or fats in the blood)—May increase risk of having pancreatitis.
- Anemia (low levels of red blood cells) or
- Pancreatitis (inflammation and swelling of the pancreas) or
- Vitamin B12 deficiency—Use with caution. May make these conditions worse.
- Angioedema (swelling of the face, lips, tongue, or throat) to similar medicines (e.g., linagliptin, sitagliptin), history of—Use with caution. Patients who have experienced this condition may be at increased risk of getting angioedema with saxagliptin.
- Congestive heart failure, acute or unstable or
- Dehydration or
- Heart attack, acute or
- Hypoxemia (decreased oxygen in the blood) or
- Kidney disease or
- Liver disease or
- Sepsis (severe infection) or
- Shock (low blood pressure, blood circulation is poor)—A rare condition called lactic acidosis can occur. Talk with your doctor if you have concerns about this.
- Diabetic ketoacidosis (ketones in the blood) or
- Kidney disease, severe or
- Liver disease, severe or
- Metabolic acidosis (acid in the blood) or
- Type I diabetes—Should not be used in patients with these conditions.
- Fever or
- Infection or
- Surgery or
- Trauma—These conditions may cause temporary problems with blood sugar control and your doctor may want to treat you with insulin.
Proper Use of saxagliptin and metformin
saxagliptin and metformin usually comes with a Medication Guide. Read the information carefully and make sure you understand it before taking saxagliptin and metformin. If you have any questions, ask your doctor.
Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.
Saxagliptin and metformin combination should be taken with the evening meal to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment.
Swallow the extended-release tablet whole. Do not crush, break, or chew it.
While taking the extended-release tablet, part of the tablet may pass into your stools. This is normal and is nothing to worry about.
The dose of saxagliptin and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of saxagliptin and metformin. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (extended-release tablets):
- For type 2 diabetes:
- For patients taking metformin alone:
- Adults—The metformin dose is the same as the dose you are already taking. Your doctor may adjust your dose until your blood sugar is controlled. However, the dose is usually not more than 5 milligrams (mg) of saxagliptin and 2000 mg of metformin once a day.
- Children—Use and dose must be determined by your doctor.
- For patients taking saxagliptin alone:
- Adults—At first, one tablet containing 5 milligrams (mg) of saxagliptin and 500 mg of metformin once a day. Your doctor may gradually increase your dose until your blood sugar is controlled. However, the dose is usually not more than 5 mg of saxagliptin and 2000 mg of metformin once a day.
- Children—Use and dose must be determined by your doctor.
- For patients using 2.5 milligrams (mg) of saxagliptin and extended-release metformin together:
- Adults—One tablet containing 2.5 mg of saxagliptin and 1000 mg of metformin once a day.
- Children—Use and dose must be determined by your doctor.
- For patients taking metformin alone:
- For type 2 diabetes:
If you miss a dose of saxagliptin and metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using saxagliptin and metformin
Your doctor will want to check your progress at regular visits, especially during the first few weeks that you take saxagliptin and metformin. Blood and urine tests may be needed to check for unwanted effects.
Let your doctor or dentist know you are taking saxagliptin and metformin. Your doctor may advise you to temporarily stop taking saxagliptin and metformin before you have major surgery or diagnostic tests including procedures that use contrast dye.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. Symptoms of lactic acidosis include: abdominal or stomach discomfort; decreased appetite; diarrhea; fast or shallow breathing; a general feeling of discomfort; muscle pain or cramping; and unusual sleepiness, tiredness, or weakness.
If symptoms of lactic acidosis occur, you should get immediate emergency medical help.
Pancreatitis (swelling and inflammation of the pancreas) may occur while you are using saxagliptin and metformin. Stop using saxagliptin and metformin and check with your doctor right away if you have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.
saxagliptin and metformin may cause serious types of allergic reactions, including anaphylaxis and angioedema. These conditions may be life-threatening and require immediate medical attention. Stop using saxagliptin and metformin and check with your doctor right away if you have a rash; itching; a large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs; trouble with breathing; or chest tightness while you are using saxagliptin and metformin.
It is very important to carefully follow any instructions from your health care team about:
- Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
- Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
- Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur with lifestyle changes, such as changes in exercise or diet. Furthermore, counseling on contraception and pregnancy may be needed, because of the problems that can occur in patients with diabetes during pregnancy.
- Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
- In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes and that lists all of your medicines.
Saxagliptin and metformin combination can cause low blood sugar. However, this can also occur if you delay or miss a meal or snack, drink alcohol, exercise more than usual, cannot eat because of nausea or vomiting, take certain medicines, or take saxagliptin and metformin combination with another type of diabetes medicine. The symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so you can treat it quickly.
Symptoms of hypoglycemia (low blood sugar) include: anxiety; behavior changes similar to being drunk; blurred vision; cold sweats; confusion; cool, pale skin; difficulty with thinking; drowsiness; excessive hunger; fast heartbeat; headache (continuing); nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; or unusual tiredness or weakness.
If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes; or drink fruit juice, non-diet soft drink, or sugar dissolved in water. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. The members of your household should also know how to use it.
Symptoms of hyperglycemia (high blood sugar) include: blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination (frequency and volume); ketones in the urine; loss of appetite; sleepiness; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; or unusual thirst.
High blood sugar may occur if you do not exercise as much as usual, have a fever or infection, do not take enough or skip a dose of your diabetes medicine, or overeat or do not follow your meal plan.
If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.
saxagliptin and metformin is only part of a complete program for controlling diabetes. It is important that you always eat a healthy diet, watch your weight, and get regular exercise.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
saxagliptin and metformin Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- bladder pain
- bloody or cloudy urine
- blurred vision
- body aches or pain
- cold sweats
- cool, pale skin
- difficult, burning, or painful urination
- difficulty with breathing
- ear congestion
- fast heartbeat
- frequent urge to urinate
- increased hunger
- loss of voice
- lower back or side pain
- nasal congestion
- runny nose
- slurred speech
- sore throat
- unusual tiredness or weakness
- Cough or hoarseness
- Black, tarry stools
- bleeding gums
- blood in the urine or stools
- darkened urine
- difficulty with swallowing
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- pains in the stomach, side, or abdomen, possibly radiating to the back
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- shortness of breath
- skin rash
- tightness in the chest
- unusual bleeding or bruising
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- muscle aches
- stuffy nose
- Abdominal or stomach pain
- pain or tenderness around the eyes and cheekbones
- redness of the skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
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More about metformin/saxagliptin
- Other brands: Kombiglyze XR