saxagliptin
saxagliptin
Pharmacologic class: Dipeptidyl peptidase-4 (DPP-4) inhibitor
Therapeutic class: Hypoglycemic
Pregnancy risk category B
Action
Inhibits DPP-4 and slows inactivation of incretin hormones, thereby increasing blood concentrations and reducing fasting and postprandial glucose concentrations in a glucose-dependent manner in patients with type 2 diabetes mellitus
Availability
Tablets: 2.5 mg, 5 mg
Indications and dosages
➣ Adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus
Adults: 2.5 to 5 mg P.O. daily
Dosage adjustment
• Moderate, severe, or end-stage renal disease
• Concurrent use of strong CYP450 inhibitors
Contraindications
• History of serious hypersensitivity to drug (such as anaphylaxis, angioedema, or exfoliative skin conditions)
Precautions
Use cautiously in:
• renal impairment, history of pancreatitis
• concurrent use of insulin secretagogues or strong CYP450 and CYP3A4/5 inhibitors
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
• Assess renal function before starting therapy.
See Before starting drug, identify possible risk factors for pancreatitis, such as history of pancreatitis, alcoholism, gallstones, or hypertriglyceridemia.
• Administer without regard to meals.
• Be aware that drug shouldn't be used for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis.
Adverse reactions
CNS: headache
EENT: sinusitis
GI: vomiting, abdominal pain, gastroenteritis, acute pancreatitis
GU: urinary tract infection
Metabolic: hypoglycemia
Respiratory: upper respiratory tract infection
Skin: urticaria, exfoliative skin conditions
Other: peripheral edema, facial edema, hypersensitivity (including anaphylaxis and angioedema)
Interactions
Drug-drug. Insulin secretagogues (such as sulfonylureas): possible increased risk of hypoglycemia
Strong CYP3A4/5 inhibitors (such as atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin): significantly increased saxagliptin effect
Drug-diagnostic tests. Lymphocytes: decreased count
Drug-food. Any food: increased saxagliptin area under the curve
Patient monitoring
• Monitor blood glucose and hemoglobin A1C levels and renal function tests periodically during therapy.
• Monitor CBC with differential, particularly lymphocyte count, in patients with unusual or prolonged infection.
See Observe patient carefully for signs and symptoms of pancreatitis. If pancreatitis is suspected, promptly discontinue drug and initiate appropriate management.
Patient teaching
• Tell patient to take drug with or without food. Tell patient not to split or cut tablet.
• Teach patient about signs and symptoms of hypoglycemia (blurred vision, confusion, tremor, diaphoresis, excessive hunger, drowsiness, increased heart rate) and how to treat it, especially if taking saxagliptin with other drugs that may cause hypoglycemia.
See Instruct patient to discontinue drug and immediately report signs and symptoms of hypersensitivity reaction (such as hives, rash, or swelling of face, lips, or throat) or pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting).
• Instruct patient to routinely monitor blood glucose level at home.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and food mentioned above.
saxagliptin
(sax-a-glip-tin) saxagliptin,Onglyza
(trade name)Classification
Therapeutic: antidiabeticsPharmacologic: dipeptidyl peptidase4 ddp4 inhibitors
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (DDP-4 inhibition)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | unknown | 2 hr (4 hr for 5–hydroxysaxagliptin)† | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
Cardiovascular
- peripheral edema (↑ with thiazolidinediones)
Gastrointestinal
- pancreatitis (life-threatening)
- abdominal pain
- vomiting
Hematologic
- ↓ lymphocyte count
Endocrinologic
- hypoglycemia (↑ with sulfonylureas)
Miscellaneous
- hypersensitivity reactions (anaphylaxis, angioedema, exfoliative skin disorders) (life-threatening)
Interactions
Drug-Drug interaction
Strong CYP3A4/5 inhibitors, including ketoconazole, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir, and telithromycin ↑ blood levels; daily dose should not exceed 2.5 mg.↑ risk of hypoglycemia with sulfonylureas or insulin ; may need to ↓ dose of sulfonylureas or insulin.Route/Dosage
Renal Impairment
Oral (Adults) CCr ≤50 mL/min—2.5 mg once daily.Availability
Nursing implications
Nursing assessment
- Observe patient for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety).
- Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back) during therapy. If pancreatitis occurs, discontinue saxagliptin and monitor serum and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, and lipase.
- Lab Test Considerations: Monitor hemoglobin A1C prior to and periodically during therapy.
- Monitor renal function prior to and periodically during therapy.
- May cause ↓ absolute lymphocyte count.
Potential Nursing Diagnoses
Imbalanced nutrition: more than body requirements (Indications)Noncompliance (Patient/Family Teaching)
Implementation
- Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
- Oral: May be administered without regard to food. Swallow tablet whole, do not cut or split.
Patient/Family Teaching
- Instruct patient to take saxagliptin as directed. If a dose is missed, take the next dose as prescribed; do not double doses. Advise patient to read the Patient Package Insert before starting and with each Rx refill; new information may be available.
- Explain to patient that saxagliptin helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
- Instruct patient not to share this medication with others, even if they have the same symptoms; it may harm them.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
- Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
- Instruct patient in proper testing of blood glucose and urine ketones. These tests should be monitored closely during periods of stress or illness and health care professional notified if significant changes occur.
- Advise patient to notify health care professional promptly if swelling of hands, feet, or ankles; rash; hives; or swelling of face, lips, or throat occur.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
- Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
Evaluation/Desired Outcomes
- Improved hemoglobin A1C, fasting plasma glucose and 2-hr post-prandial glucose levels.