Home Drug Guide Dapagliflozin and Saxagliptin

Drug Guide

Generic Name

Dapagliflozin and Saxagliptin

Brand Names Qtern

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Combination of SGLT2 inhibitor and DPP-4 inhibitor

FDA Approved Indications

Type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Dapagliflozin inhibits sodium-glucose co-transporter 2 (SGLT2) in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. Saxagliptin inhibits dipeptidyl peptidase-4 (DPP-4), prolonging the activity of incretin hormones, which increase insulin synthesis and release, and decrease glucagon levels.

Dosage and Administration

Adult: Typically 5 mg of dapagliflozin and 5 mg of saxagliptin once daily, titrating based on response.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider renal function.

Renal Impairment: Dose adjustment may be necessary based on renal function assessments.

Hepatic Impairment: Use with caution; no specific dose adjustment necessary.

Pharmacokinetics

Absorption: Rapidly absorbed after oral dosing.

Distribution: Dapagliflozin 91% protein bound; Saxagliptin approximately 22% protein bound.

Metabolism: Dapagliflozin is metabolized primarily through glucuronidation; Saxagliptin is metabolized by CYP3A4/5.

Excretion: Dapagliflozin excreted mainly via feces; Saxagliptin and its metabolites excreted in urine and feces.

Half Life: Dapagliflozin approximately 13 hours; Saxagliptin approximately 2.5 hours.

Contraindications

Known hypersensitivity to dapagliflozin, saxagliptin, or other components.

Precautions

History of ketoacidosis, renal impairment, or urinary tract infections. Use with caution in patients age >75, as saxagliptin has been associated with heart failure risk.

Adverse Reactions - Common

Genital mycotic infections (Common)
Urinary tract infections (Common)
Hypoglycemia (more likely when combined with insulin or insulin secretagogues) (Less common)

Adverse Reactions - Serious

Ketoacidosis (Rare)
Acute kidney injury (Rare)
Heart failure exacerbation with saxagliptin (While uncommon, monitor patients with heart failure.)

Drug-Drug Interactions

Diuretics, possibly increasing hypotension risk.
Insulin and secretagogues, increasing hypoglycemia risk.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels, renal function, and signs of infections.

Diagnoses:

Risk for hypoglycemia
Risk for urinary tract infections

Implementation: Administer once daily, preferably in the morning. Educate patients on signs of infections and ketoacidosis.

Evaluation: Assess for reduction in HbA1c, monitor for adverse effects, and renal function.

Patient/Family Teaching

Take medication as prescribed, at the same time each day.
Maintain good urinary hygiene to reduce infection risk.
Report symptoms of urinary discomfort, genital infections, or ketoacidosis.

Special Considerations

Black Box Warnings:

Risk of heart failure hospitalization with saxagliptin in some patients.

Genetic Factors: No specific genetic considerations.

Lab Test Interference: Potential alterations in renal and hepatic function tests.

Overdose Management

Signs/Symptoms: Severe hypotension, dehydration, hypoglycemia.

Treatment: Supportive care, discontinuation of drug, hydration, and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable up to the expiration date on the package.