A DPP-4 inhibitor (gliptin) for type 2 diabetes
Saxagliptin
A once-daily DPP-4 inhibitor (gliptin) that gently lowers blood sugar in type 2 diabetes with a low risk of hypoglycaemia on its own; used with caution in heart failure.
What is Saxagliptin?
Saxagliptin is a DPP-4 inhibitor (a 'gliptin') used once a day to lower blood sugar in type 2 diabetes. It helps the body release more of its own insulin after meals, and on its own it has a low risk of hypoglycaemia (low blood sugar) and is generally weight-neutral. It is used with extra caution in people with heart failure, and pancreatitis is an uncommon but recognised risk.
Education and reference only. This is a plain-language guide to Saxagliptin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Saxagliptin is a DPP-4 inhibitor, one of the 'gliptin' diabetes tablets, used in the UK to lower blood sugar in type 2 diabetes. It is taken once a day and is often added to metformin or another diabetes medicine, and it is also available combined with metformin in a single tablet. It works mainly around mealtimes to gently improve blood sugar, usually without causing low blood sugar or weight gain on its own. It works quietly in the background to improve overall blood sugar control.
How it works
After eating, the gut releases hormones called incretins (such as GLP-1) that prompt the pancreas to release insulin and reduce a sugar-raising hormone called glucagon. These incretins are quickly broken down by an enzyme called DPP-4. Saxagliptin blocks DPP-4, so the incretins last longer, increasing insulin release and lowering glucagon after meals. Because this mainly happens when blood sugar is rising after food, it is less likely to push blood sugar too low than a sulfonylurea.
Company & origin
Originated / developed by: Developed by Bristol-Myers Squibb and AstraZeneca..
Saxagliptin is a DPP-4 inhibitor developed by Bristol-Myers Squibb and AstraZeneca and introduced around 2009 for type 2 diabetes.
What it treats
Conditions Saxagliptin is used for
Practical use
How to take Saxagliptin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day as prescribed; it can usually be taken with or without food.
- Keep up your usual meals, diet and activity, as it works alongside lifestyle measures rather than replacing them.
- Tell your prescriber if you have heart failure or notice new or worsening breathlessness, ankle swelling or sudden weight gain.
- Seek urgent medical help for severe, persistent stomach pain, especially if it spreads to your back, as this can signal pancreatitis.
- If you also take a sulfonylurea or insulin, be aware that low blood sugar becomes more likely and know how to treat it.
- Attend your blood tests, as the dose may need adjusting if your kidney function is reduced.
Weighing it up
Advantages & disadvantages of Saxagliptin
Advantages
- On its own it has a low risk of hypoglycaemia, unlike sulfonylureas.
- It is taken once a day and is generally weight-neutral.
- It is well tolerated by most people and can be combined with metformin, including in a single tablet.
Disadvantages
- It is used with caution in heart failure, as it may slightly increase the risk of heart-failure hospital admissions.
- It carries an uncommon risk of pancreatitis (inflammation of the pancreas).
- Its blood-sugar-lowering effect is modest, and it has not been shown to protect the heart or kidneys the way SGLT2 inhibitors and GLP-1 medicines can.
Practical use
Good to know
On its own, saxagliptin has a low risk of low blood sugar and does not usually cause weight gain, which makes it a gentle option; the hypo risk rises if it is combined with a sulfonylurea or insulin. An important caution is heart failure: studies suggested saxagliptin may slightly increase hospital admissions for heart failure, so it is used carefully in people with, or at risk of, heart failure, and you should report new or worsening breathlessness, ankle swelling or rapid weight gain. As with other gliptins, there is an uncommon risk of pancreatitis — seek urgent advice for severe, persistent tummy pain that may spread to the back. The dose may be adjusted if your kidney function is reduced.
Who should not take it / use with caution
- People with type 1 diabetes or diabetic ketoacidosis.
- People with heart failure should use it only with caution and review, given the possible increased risk of heart-failure admissions.
- People who have had pancreatitis should use it with caution, and anyone with a serious allergy to saxagliptin should avoid it.
Monitoring
- Regular checks of blood sugar control, usually including an HbA1c blood test.
- Kidney function checks, as the dose may need adjusting if kidney function is reduced.
- Watching for signs of heart failure, pancreatitis or low blood sugar, especially if combined with other diabetes medicines.
Side effects
- Generally well tolerated; possible headache, dizziness or mild digestive upset.
- Upper respiratory or urinary tract infections in some people.
- Worsening of heart failure in those at risk (report breathlessness, ankle swelling or rapid weight gain).
- Rarely, pancreatitis (severe, persistent stomach pain) — seek urgent help.
Key interactions
- Combining it with a sulfonylurea or insulin increases the risk of low blood sugar.
- Strong CYP3A4/5 inhibitors (for example ketoconazole) can raise saxagliptin levels, so the dose may be limited.
- Other medicines used for heart failure should be reviewed as part of overall care.
Available as: Tablets taken by mouth, including a form combined with metformin in a single tablet.
Answers
Saxagliptin: frequently asked questions
What is saxagliptin and how does it work?
Saxagliptin is a DPP-4 inhibitor, or 'gliptin', for type 2 diabetes. It blocks an enzyme that breaks down gut hormones called incretins, so they last longer and help the pancreas release more insulin and lower a sugar-raising hormone after meals, gently improving blood sugar.
Can saxagliptin cause low blood sugar?
On its own it has a low risk of low blood sugar, because it mainly works as blood sugar rises after food. The risk increases if it is combined with a sulfonylurea or insulin, so in that case it is important to know how to recognise and treat a hypo.
Why is saxagliptin used with caution in heart failure?
Studies suggested saxagliptin may slightly increase hospital admissions for heart failure. Because of this, it is used carefully in people with, or at risk of, heart failure, and you should report new or worsening breathlessness, ankle swelling or rapid weight gain.
Does saxagliptin cause weight gain?
It is generally weight-neutral, so it does not usually cause weight gain, which can be an advantage over sulfonylureas. It is taken once a day and is often combined with metformin for better blood sugar control.
What is the warning sign of pancreatitis?
Pancreatitis is uncommon but recognised with gliptins. The main warning sign is severe, persistent stomach pain that may spread to your back, often with vomiting. If this happens, stop the medicine and seek urgent medical help.
The wider class
About DPP-4 inhibitors
Saxagliptin belongs to the dpp-4 inhibitors class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.