Saxagliptin (Onglyza): What You Need to Know

If you or someone you care for has type 2 diabetes, saxagliptin may be on the table. It’s an oral drug that helps lower blood sugar by helping your body make more insulin after meals. People like it because it’s a once-daily pill and usually doesn’t cause weight gain.

Here are the basics you can use right away: saxagliptin is a DPP-4 inhibitor approved to improve blood sugar control along with diet and exercise. It’s not for type 1 diabetes or diabetic ketoacidosis. You’ll still need routine blood sugar checks and A1c tests to see if it’s working.

How to take saxagliptin and dosing tips

Typical dose: 5 mg once daily. If you have reduced kidney function (creatinine clearance ≤50 mL/min) or you take strong CYP3A4/5 inhibitors like ketoconazole, your doctor may lower the dose to 2.5 mg once daily. Take it at the same time each day, with or without food. If you miss a dose, take it as soon as you remember unless it’s almost time for the next dose—don’t double up.

Don’t use saxagliptin alone if you need rapid insulin—this drug works best for people with residual insulin production. If your doctor adds it to insulin or a sulfonylurea, watch closely for low blood sugar and know how to treat it (juice, glucose tablets).

Side effects, warnings, and what to watch for

Common side effects include upper respiratory symptoms, urinary tract infections, and headache. Some people report joint pain or swelling. A rare but serious risk is pancreatitis—get medical help for severe belly pain that may radiate to the back. Studies found a small increased risk of heart failure with saxagliptin in people with existing heart disease or kidney problems. Tell your doctor right away if you notice shortness of breath, sudden weight gain, or ankle swelling.

Drug interactions matter. Powerful inhibitors of CYP3A4/5 can raise saxagliptin levels, so your doctor may cut the dose. Also be careful combining saxagliptin with insulin or drugs that lower glucose—low blood sugar can happen.

Before you start, tell your provider about kidney or liver problems, recent pancreatitis, heart failure, pregnancy, or breastfeeding. Women who are pregnant or planning pregnancy should discuss options—saxagliptin isn’t a typical first choice in pregnancy.

Practical tips: carry a fast sugar source, check blood sugar more often when starting or changing doses, and keep a list of all medicines and supplements for your prescriber. If you notice new symptoms like severe abdominal pain, persistent cough, swelling, or fainting, contact a healthcare professional.

Saxagliptin can help lower A1c when used with lifestyle changes and other treatments. Ask your doctor if it fits your routine and health profile, and keep regular follow-ups to track results and safety.