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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.