Onglyza Side Effects

Onglyza and Kombiglyze XR are oral medications that treat Type 2 diabetes. Kombiglyze XR combines the active ingredient in Onglyza, saxagliptin, with metformin extended release.

The most common side effects of these two drugs are respiratory and urinary tract infections, headache, diarrhea and nausea. In general, common side effects occurred in 5 percent or more of clinical trial participants.

The drugs’ labels include information about these side effects based on data gathered from five clinical trials with 882 participants.

The patients — primarily white adults with an average age of 55 years — took saxagliptin for about 21 weeks. More people who took the higher dose of 5 mg suffered side effects and dropped out of clinical trials.

In addition to clinical trial data, manufacturer AstraZeneca reported side effects data gathered from postmarketing reports. Postmarketing data comes from patients who use the drug once it is on the market.

Patients and doctors report side effects to the U.S. Food and Drug Administration’s Adverse Events Reporting System (FAERS). One important thing to note is that FAERS is a voluntary reporting system and can’t verify whether the drug actually caused the side effect. The FDA also says it’s possible for a drug to cause more problems than people report.

FAERS received 3,927 reports of Onglyza adverse events from 2009 to Sept. 30, 2018, including 242 deaths. Gastrointestinal and cardiac disorders topped the list of most-reported health issues.

Along with the common side effects, studies and postmarketing reports link saxagliptin to serious side effects such as heart failure, pancreatitis and severe joint pain. Kombiglyze XR also has a black box warning for lactic acidosis, a condition where toxic lactic acid builds up in the blood.

In April 2016, the FDA released a Drug Safety Communication warning about an increased risk of heart failure with saxagliptin. The agency required the makers of Onglyza and Kombiglyze XR to add warnings to the medication labels.

“A U.S. Food and Drug Administration (FDA) safety review has found that Type 2 diabetes medicines containing saxagliptin and alogliptin may increase the risk of heart failure, particularly in patients who already have heart or kidney disease,” the FDA said. “As a result, we are adding new warnings to the drug labels about this safety issue.”

The FDA studied clinical trial data that showed more people who took saxagliptin or alogliptin — a similar drug — ended up in the hospital for heart failure than those who took a placebo. For saxagliptin, the risk was about 35 patients out of every 1,000.

A 2022 study in the Journal of the American College of Cardiology reaffirmed the findings that saxagliptin increased the risk of hospitalization for heart failure.

Although Onglyza may increase the risk of heart failure, the risk may not be as high as with other diabetes drugs. A large cohort study of more than 376,000 patients found the risk of being hospitalized for heart failure was lower among saxagliptin users than among patients who used pioglitazone (brand name Actos) or long-acting insulin treatment.

Author Sengwee Toh and colleagues published the results in April 2016 in the Annals of Internal Medicine. They used records collected by 18 data partners to look at adults with Type 2 diabetes who started taking the drugs between 2006 and 2013. They concluded more research is needed to better understand the risk.

Some people who suffered heart failure and other heart problems filed Onglyza lawsuits claiming the drug’s maker did not properly warn of the risk.

Onglyza and other medications in the same class called dipeptidyl peptidase-4 (DPP-4) inhibitors carry warnings for an increased risk of pancreatitis.

Postmarketing reports show a small number of people who took Onglyza suffered acute pancreatitis. The drug’s label cautions that patients should be “observed carefully” for signs of the condition after starting the drug.

Researchers conducting a trial confirmed definite acute pancreatitis in 0.2 percent of participants who took Onglyza compared to 0.1 percent of people who received the placebo. About 88 percent of the Onglyza users and all of the placebo-treated participants had pre-existing risk factors for pancreatitis.

Practical Diabetes published the case report of a 33-year-old man who suffered acute pancreatitis after he started taking Onglyza and then switched to Kombiglyze XR. He went to the hospital complaining of dizziness, vomiting, palpitations and breathlessness.

Doctors performed tests and found fluid around the pancreas and swelling. The tail of the pancreas also had dying tissue. They diagnosed him with acute pancreatitis. After they replaced Kombiglyze XR with insulin and metformin, the patient went home in stable condition.

Some patients reported severe and disabling joint pain after taking Onglyza, Kombiglyze XR or other DPP-4 inhibitors. This side effect is rare, but in 2015, the FDA required drugmakers to place warnings on the medication inserts.

The agency had analyzed postmarketing reports submitted between Oct. 16, 2006 and Dec. 31, 2013 and found five reports of joint pain associated with saxagliptin, according to a 2015 Drug Safety Communication.

As of Sept. 30, 2018, the number had risen to 41 reports of arthralgia for Onglyza and 13 reports of arthralgia for Kombiglyze XR in FAERS. Twenty-three reported cases were serious and three involved deaths.

“Patients should not stop taking their DPP-4 inhibitor medicine, but should contact their health care professional right away if they experience severe and persistent joint pain,” the FDA said in 2015. “Health care professionals should consider DPP-4 inhibitors as a possible cause of severe joint pain and discontinue the drug if appropriate.”

Symptoms may occur any time after beginning treatment. People who reported joint pain said their symptoms started anywhere from one day to one year after starting the drug, according to Onglyza’s insert. The pain went away after the patients stopped taking the drug — typically in less than 30 days. But in some patients, the pain came back once they started therapy again.

Case ‘Important’ in Bringing Attention to Potential Side Effect, Doctors Say

Dr. Akshay C. Dahiwele and colleagues reported a rare case of knee arthralgia caused by saxagliptin in the September-October 2016 edition of International Journal of Basic & Clinical Pharmacology.

A 55-year-old woman with Type 2 diabetes had already been taking 2,000 mg of metformin a day when her doctor added 5 mg of saxagliptin to her daily regimen. After two months of taking saxagliptin, she reported pain in both her knees.

Doctors ruled out osteoarthritis, gout and other types of possible joint pain. They discontinued saxagliptin, and the symptoms improved.

“We consider that this case is important in bringing this potential side effect to the attention of both pharmacologists and primary care physicians,” the authors wrote.