You typed a brand name and want straight answers-what it is, whether it’s right for you, how to take it safely, and where to find the official leaflets fast. This page gives you the shortest route to trusted UK sources and the key safety points doctors actually watch. No fluff, just practical steps and evidence you can check with your GP or pharmacist.
What you’re likely trying to get done right now:
- Confirm what Onglyza (saxagliptin) is and who it’s for.
- Jump to the official UK patient leaflet (PIL) and healthcare SmPC without hunting.
- Know the usual dose, kidney dose changes, and common interactions.
- Spot side effects you shouldn’t ignore, including the heart failure warning.
- Compare with alternatives if this isn’t a fit (SGLT2, GLP-1, other DPP-4s).
What Onglyza is and who it’s for (plain-English quick facts)
Onglyza is the brand name for saxagliptin, a DPP-4 inhibitor for adults with type 2 diabetes. It helps your body boost its own insulin response after meals and lowers glucagon (the hormone that raises blood sugar). It’s meant to be used with diet and exercise, sometimes on its own, but more often alongside metformin, a sulfonylurea, a thiazolidinedione, or insulin. In the UK, there’s also a combined tablet with metformin called Komboglyze.
Who it’s typically for: people with type 2 diabetes who need an extra A1c (HbA1c) drop but want something weight-neutral and with low hypoglycaemia risk when used without insulin or a sulfonylurea. NICE guidance (NG28, updated through 2024) positions DPP-4 inhibitors as options when SGLT2 inhibitors aren’t suitable or tolerated, or as add-ons in specific combinations. If you have cardiovascular or kidney disease, the NHS often prefers an SGLT2 inhibitor first-line, if appropriate, because of heart/renal protection benefits those drugs have shown.
Who it’s not for: it’s not used in type 1 diabetes, never for diabetic ketoacidosis, and not for children. If you have a history of pancreatitis or significant heart failure, your clinician will weigh this carefully or choose something else.
How well it works: most people see an HbA1c drop of about 0.5-0.8%. It’s weight-neutral. On its own, it doesn’t usually cause hypos, but the risk rises if you also take insulin or a sulfonylurea. Cardiovascular outcome trials showed saxagliptin was neutral for major heart events, but one trial flagged a higher rate of hospitalisation for heart failure-more on that below.
Safety headlines you should know now:
- Heart failure risk: the SAVOR-TIMI 53 trial (NEJM, 2013) found higher heart failure hospitalisations with saxagliptin vs placebo. Regulators (FDA, EMA/MHRA) added warnings in 2016. Tell your doctor quickly if you get breathless, gain weight fast, or notice swollen ankles.
- Pancreatitis warning: seek urgent care if you get severe, persistent belly pain that may go to the back, with or without vomiting.
- Severe joint pain (rare), skin blisters (possible bullous pemphigoid), and allergic reactions (including angioedema) need prompt medical attention.
| Quick fact | What it means in practice |
|---|---|
| Active ingredient / class | Saxagliptin / DPP-4 inhibitor |
| Approved use | Adults with type 2 diabetes, as an adjunct to diet and exercise; monotherapy if metformin not suitable, or add-on to metformin, sulfonylurea, thiazolidinedione, or insulin |
| Usual dose | 5 mg once daily |
| Kidney function adjustment | 2.5 mg once daily if eGFR ≤45 mL/min/1.73 m² or on dialysis (usually after dialysis on dialysis days) |
| Strong CYP3A4/5 inhibitors | Reduce to 2.5 mg daily when used with drugs like ketoconazole, clarithromycin, atazanavir, etc. |
| Hypoglycaemia | Low risk alone; risk increases with insulin/sulfonylurea-those doses may need review |
| Expected HbA1c effect | About 0.5-0.8% reduction |
| Weight effect | Generally weight-neutral |
| Heart failure signal | SAVOR-TIMI 53 showed more hospitalisations for heart failure vs placebo; UK/EU and US warnings in place |
Fast navigation: get to the right Onglyza pages without hunting
If you just need the official leaflets or the NHS page, use these exact steps. No bookmarking needed-just the search phrases and the page titles you should see.
- Patient Leaflet (PIL) and SmPC (UK, healthcare professionals): search for “emc Onglyza SmPC” in your browser. The result you want typically reads “Onglyza 5 mg film-coated tablets - Summary of Product Characteristics (SmPC)” and “Package Leaflet: Information for the patient” on the Medicines.org.uk (emc) site. This is the UK authority-hosted copy most pharmacists use.
- NHS Medicines A-Z overview: search “NHS saxagliptin” or “NHS DPP-4 inhibitors diabetes”. The NHS pages explain who can take it, side effects in plain English, and practical tips.
- NICE guidance (clinical context): search “NICE NG28 type 2 diabetes adults”. This is the UK guideline that sets where DPP-4 inhibitors fit vs SGLT2 inhibitors and GLP‑1 receptor agonists.
- Regulatory safety updates (UK): search “MHRA saxagliptin heart failure warning” or “Drug Safety Update saxagliptin”. You’ll find MHRA notes from 2016 onwards about heart failure risk.
- BNF/BNFc (dosing, interactions in one place): search “BNF saxagliptin”. Look for the British National Formulary entry. This is what clinicians check at the point of prescribing.
- Company info: search “AstraZeneca Onglyza prescribing information”. Useful if you want brand-specific support materials. For UK-specific details, always compare with the emc SmPC.
Tip: If you’re at your GP practice or pharmacy in England, the team often opens the emc SmPC first, then the BNF for interaction checks, and finally the NHS patient page to print a plain-English summary.
About access and costs in the UK: this is a prescription‑only medicine. Standard NHS prescription rules apply. In Scotland, Wales, and Northern Ireland, prescriptions are free; in England, the standard prescription charge applies per item unless you’re exempt or on a prepayment certificate.
How to use it safely: dose, interactions, and red flags
Usual dose and timing: one tablet daily, with or without food, taken at about the same time each day. The standard adult dose is 5 mg once daily.
Kidney function matters: if your eGFR is 45 or lower, the dose is 2.5 mg daily. If you’re on haemodialysis, 2.5 mg is usually taken after the dialysis session on dialysis days. Your team will check kidney function before starting and then periodically.
Liver issues: mild or moderate liver impairment generally doesn’t need a dose change, but your prescriber will decide. Severe liver disease requires a careful, individual assessment.
Drug interactions to know about:
- Strong CYP3A4/5 inhibitors (for example ketoconazole, itraconazole, clarithromycin, atazanavir, ritonavir-boosted regimens): cut the dose to 2.5 mg daily while on these.
- Strong enzyme inducers (like rifampicin, carbamazepine): may reduce saxagliptin levels and effectiveness-your clinician may choose a different agent.
- Insulin or sulfonylurea (e.g., gliclazide): hypoglycaemia risk rises. Watch for sweating, shakiness, hunger, blurry vision; your clinician may lower the insulin or SU dose.
Food, alcohol, and driving: you can take it with or without food. Alcohol can push glucose down or up depending on amount and context-if you drink, keep it moderate and consistent. Hypos are unlikely on saxagliptin alone, but if you drive and also use insulin or a sulfonylurea, follow DVLA rules and keep fast-acting carbs on hand.
What side effects to expect vs what needs help:
- Common: sore throat, runny nose, cough, urinary tract infection, headache, mild stomach upset. If mild, these often pass; mention them at your next review.
- Allergic reactions: rash, hives, swelling of lips/face/tongue, trouble breathing-seek urgent help.
- Pancreatitis: severe stomach pain that won’t go away, often to the back, with or without vomiting-go to urgent care.
- Heart failure symptoms: new or worse breathlessness (especially when lying flat), sudden weight gain, ankle swelling-contact your GP promptly or seek urgent care if severe.
- Severe joint pain or blistering skin (possible bullous pemphigoid): stop the medicine and get medical advice quickly.
Evidence at a glance: SAVOR-TIMI 53 (NEJM, 2013) showed saxagliptin was neutral for major atherosclerotic events but increased hospitalisations for heart failure. The FDA and EMA/MHRA issued safety communications in 2016 to reflect this. For context, EXAMINE (alogliptin) suggested a similar heart failure signal, while TECOS (sitagliptin) did not, and CARMELINA/CAROLINA (linagliptin) were neutral.
Who should be cautious or avoid it:
- Type 1 diabetes or diabetic ketoacidosis-this is not the right medicine.
- History of pancreatitis-risk-benefit needs careful weighing.
- Current or past heart failure-discuss risks and alternatives; your clinician may prefer a drug with proven heart benefits (for example an SGLT2 inhibitor).
- Serious allergic reactions to DPP‑4 inhibitors-avoid.
Pregnancy and breastfeeding: data are limited. In pregnancy, insulin is often preferred. If you’re pregnant or planning, speak to your diabetes team before starting or continuing saxagliptin. Breastfeeding decisions should be individualised with your clinician.
Monitoring plan that actually helps:
- Before starting: kidney function (eGFR), HbA1c, and a quick check of heart failure history.
- After starting: HbA1c at about 3 months to confirm response; kidney function periodically; monitor for heart failure and pancreatitis symptoms.
- If HbA1c hasn’t budged by 0.5% or more after 3-6 months, NICE encourages switching strategy rather than stacking meds that aren’t helping.
Everyday tips:
- Pick a daily trigger: breakfast mug, phone alarm, or the 8 pm news-whatever you never miss.
- Travelling? Keep tablets in original packaging; time zones don’t matter much-take your daily dose at your “usual” time anchored to local time.
- Illness (flu, vomiting): if you can’t keep fluids down or are vomiting, check sick‑day rules with your clinician or NHS 111.
FAQ and next steps (including quick troubleshooting)
What if I miss a dose? If it’s within a few hours, take it when you remember. If it’s nearly time for the next dose, skip the missed one-don’t double up.
Can I take it with metformin? Yes-very common. If you struggle with metformin stomach upset, ask about extended‑release metformin or the combined tablet (Komboglyze) if appropriate.
Is it safe with my heart history? If you’ve had heart failure or have symptoms, discuss this first. The heart failure signal with saxagliptin means many clinicians lean toward an SGLT2 inhibitor if suitable.
Will I lose weight on it? No. It’s generally weight‑neutral. If weight loss is a priority and appropriate for you, GLP‑1 receptor agonists or SGLT2 inhibitors are usually the go‑to choices.
How fast does it work? You’ll start seeing better daily glucose within days to weeks. The HbA1c check at ~3 months tells you the full effect.
Can it cause hypos? On its own, it rarely does. The risk rises if you also take insulin or a sulfonylurea-your prescriber may lower those doses after you start.
What about surgery or fasting (including Ramadan)? For short fasts, most people continue as normal; discuss your overall regimen with your team, especially if you also use insulin or sulfonylureas. For planned surgery, bring all medicines to your pre‑op check; your hospital team will advise.
How does it stack up against similar drugs?
- Sitagliptin (DPP‑4): similar A1c drop, neutral on heart failure in TECOS.
- Linagliptin (DPP‑4): similar A1c drop, no kidney dose adjustment needed.
- Alogliptin (DPP‑4): EXAMINE hinted at a heart failure signal.
- SGLT2 inhibitors (e.g., empagliflozin): A1c drop plus proven heart/kidney benefits in many; cause more genital infections and need kidney function thresholds.
- GLP‑1 receptor agonists (e.g., semaglutide): stronger A1c drop and weight loss; injectable or oral options; GI side effects common at start.
Decision shortcuts you can use with your clinician:
- If you have established cardiovascular disease, heart failure, or kidney disease: ask about an SGLT2 inhibitor first, if suitable.
- If your eGFR is low and you want to avoid dose adjustments: linagliptin may be simpler within the DPP‑4 class.
- If weight loss is a key goal: ask about GLP‑1 receptor agonists or SGLT2 inhibitors.
- If you’re close to your A1c target and just need a gentle nudge without hypos: DPP‑4 inhibitors, including saxagliptin, are often considered.
When to call your GP, pharmacy, or NHS 111 right away:
- Severe, persistent abdominal pain (possible pancreatitis).
- New or worsening breathlessness, sudden ankle swelling, or fast weight gain (heart failure signs).
- Signs of a serious allergic reaction: swelling of face/lips/tongue, difficulty breathing.
- Blistering skin or severe joint pain that stops you doing daily activities.
Troubleshooting common scenarios:
- “My sugars haven’t improved.” Check adherence first, then diet, other meds that raise glucose (like steroids), and kidney dose. If after 3-6 months HbA1c isn’t down by ~0.5%, talk about switching or adding a drug with stronger effect.
- “I’ve started wheezing or swelling after day one.” Stop the tablet and seek urgent care-this could be an allergic reaction.
- “I take clarithromycin for a chest infection.” Tell your prescriber: that’s a strong CYP3A4 inhibitor; the saxagliptin dose usually needs to be 2.5 mg during the course.
- “I have kidney disease and go for dialysis.” Your dose is typically 2.5 mg, taken after dialysis on dialysis days. Keep your dialysis team in the loop.
Exact pages to ask your clinician or pharmacist to pull up for you:
- The emc SmPC and PIL for Onglyza (UK official documents).
- BNF entry for saxagliptin (dosing and interactions at a glance).
- NHS Medicines A-Z page for saxagliptin (patient-friendly plain English).
- NICE NG28 (where DPP‑4 inhibitors fit in UK care pathways).
- MHRA Drug Safety Update on saxagliptin and heart failure.
One last sanity check before you start or continue: confirm your kidney function and other medicines, ask about heart failure history, and set a review date in 12 weeks. If the numbers don’t move the way you hoped, don’t just keep layering tablets-ask about switching to something with proven heart or kidney benefits if that suits your health profile.
Sources behind the key points here include the UK emc SmPC and PIL for Onglyza, the British National Formulary (BNF), NICE NG28, the SAVOR-TIMI 53 trial (NEJM, 2013), and MHRA safety communications from 2016 onward. Bring this summary to your next appointment and use it as a checklist-your team will appreciate how focused the chat becomes.