Label Changes for:
Onglyza (saxagliptin) tablets
Changes have been made to the WARNINGS, PRECAUTIONS and ADVERSE REACTIONS sections of the safety label.
Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) – November and December 2011
WARNINGS AND PRECAUTIONS
Use with Medications Known to Cause Hypoglycemia
- When Onglyza was used in combination with a sulfonylurea or with insulin, medications known to cause hypoglycemia, the incidence of confirmed hypoglycemia was increased over that of placebo used in combination with a sulfonylurea or with insulin. Therefore, a lower dose of the insulin secretagogue or insulin may be required to minimize the risk of hypoglycemia when used in combination with Onglyza.
Use in Combination with Insulin
- In the add-on to insulin trial, the incidence of adverse events, including serious adverse events and discontinuations due to adverse events, was similar between Onglyza and placebo, except for confirmed hypoglycemia.
- A concurrent glucose measurement was not required or was normal in some patients. Therefore, it is not possible to conclusively determine that all these reports reflect true hypoglycemia.
- In the add-on to glyburide study, the overall incidence of reported hypoglycemia was higher for Onglyza 2.5 mg and Onglyza 5 mg (13.3% and 14.6%) versus placebo (10.1%). The incidence of confirmed hypoglycemia in this study, defined as symptoms of hypoglycemia accompanied by a fingerstick glucose value of ≤50 mg/dL, was 2.4% and 0.8% for Onglyza 2.5 mg and Onglyza 5 mg and 0.7% for placebo…
- History of a serious hypersensitivity reaction to Onglyza , such as anaphylaxis, angioedema, or exfoliative skin conditions
WARNINGS AND PRECAUTIONS
- There have been postmarketing reports of acute pancreatitis in patients taking Onglyza. After initiation of Onglyza, patients should be observed carefully for signs and symptoms of pancreatitis. If pancreatitis is suspected, Onglyza should promptly be discontinued and appropriate management should be initiated. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using Onglyza.
- There have been postmarketing reports of serious hypersensitivity reactions in patients treated with Onglyza. These reactions include anaphylaxis, angioedema, and exfoliative skin conditions. Onset of these reactions occurred within the first 3 months after initiation of treatment with Onglyza , with some reports occurring after the first dose. If a serious hypersensitivity reaction is suspected, discontinue Onglyza, assess for other potential causes for the event, and institute alternative treatment for diabetes.
- Use caution in a patient with a history of angioedema to another dipeptidyl peptidase-4 (DPP4) inhibitor because it is unknown whether such patients will be predisposed to angioedema with Onglyza.
- Hypersensitivity-related events, such as urticaria and facial edema in the 5-study pooled analysis up to Week 24 were reported in 1.5%, 1.5%, and 0.4% of patients who received Onglyza 2.5 mg, Onglyza 5 mg, and placebo, respectively. None of these events in patients who received ONGLYZA required hospitalization or were reported as life-threatening by the investigators. One saxagliptin-treated patient in this pooled analysis discontinued due to generalized urticaria and facial edema.
PATIENT COUNSELING INFORMATION
- Patients should be informed that acute pancreatitis has been reported during postmarketing use of saxagliptin. Before initiating Onglyza, patients should be questioned about other risk factors for pancreatitis, such as a history of pancreatitis, alcoholism, gallstones, or hypertriglyceridemia. Patients should also be informed that persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Patients should be instructed to promptly discontinue Onglyza and contact their physician if persistent severe abdominal pain occurs.
- Patients should be informed that serious allergic (hypersensitivity) reactions, such as angioedema, anaphylaxis, and exfoliative skin conditions, have been reported during postmarketing use of saxagliptin. If symptoms of these allergic reactions (such as rash, skin flaking or peeling, urticaria, swelling of the skin, or swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing) occur, patients must stop taking Onglyza and seek medical advice promptly.