Nurses Compass
Drug Guide
Saxagliptin
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Dipeptidyl peptidase-4 (DPP-4) inhibitor
FDA Approved Indications
- Type 2 diabetes mellitus as an adjunct to diet and exercise
Mechanism of Action
Saxagliptin inhibits the enzyme DPP-4, which prolongs the activity of incretin hormones, increasing insulin release and decreasing glucagon levels in a glucose-dependent manner.
Dosage and Administration
Adult: Initially 2.5 mg once daily, may be increased to 5 mg or decreased to 2.5 mg based on clinical response and tolerability.
Pediatric: Not approved for use in pediatric patients.
Geriatric: No specific dose adjustment necessary, but monitor renal function.
Renal Impairment: Reduce dose in patients with moderate to severe renal impairment (eGFR < 50 mL/min/1.73 m²).
Hepatic Impairment: No specific adjustment necessary.
Pharmacokinetics
Absorption: Well absorbed following oral administration.
Distribution: Volume of distribution approximately 300 L.
Metabolism: Primarily metabolized via CYP3A4/5 to inactive metabolites.
Excretion: Excreted mainly in feces and urine.
Half Life: Approximately 2.5 hours.
Contraindications
- Hypersensitivity to saxagliptin or any component of the formulation.
Precautions
- Use with caution in patients with renal impairment, history of pancreatitis, or on other medications affecting glucose levels.
Adverse Reactions - Common
- Infections (nasopharyngitis, urinary tract infections) (Common)
- Headache (Common)
- Hypoglycemia (when used with insulin or sulfonylureas) (Common)
Adverse Reactions - Serious
- Pancreatitis (Rare)
- Hypersensitivity reactions, including anaphylaxis (Rare)
Drug-Drug Interactions
- Thiazolidinediones, Sulfonylureas (may increase hypoglycemia risk)
- CYP3A4 inhibitors (may increase saxagliptin levels)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood glucose levels regularly, renal function, and pancreatic enzymes.
Diagnoses:
- Risk for unstable blood glucose levels
- Risk for pancreatitis
Implementation: Administer once daily, with or without food. Educate patient on symptoms of hypoglycemia and pancreatitis.
Evaluation: Assess for reduction in blood glucose levels and any adverse effects or signs of pancreatitis.
Patient/Family Teaching
- Take medication as prescribed daily.
- Monitor blood sugar as directed.
- Report any symptoms of pancreatitis (severe abdominal pain, persistent nausea/vomiting).
- Maintain a healthy diet and exercise routine.
Special Considerations
Black Box Warnings:
- Risk of heart failure with the 5 mg dose in patients with established cardiovascular disease or risk factors.
Genetic Factors: No specific genetic testing required.
Lab Test Interference: May affect certain lab tests; consult laboratory for specifics.
Overdose Management
Signs/Symptoms: Severe hypoglycemia, hypotension.
Treatment: Supportive care; glucose administration if hypoglycemia occurs; no specific antidote.
Storage and Handling
Storage: Store at room temperature between 20°C and 25°C (68°F to 77°F).
Stability: Stable under recommended storage conditions for at least 2 years.