Onglyza vs Other Diabetes Drugs Comparison Tool
Select two diabetes medications to compare their key characteristics:
Onglyza (Saxagliptin)
DPP-4 Inhibitor
- Reduces HbA1c by 0.5-0.8%
- Low risk of hypoglycemia
- Once daily oral tablet
Januvia (Sitagliptin)
DPP-4 Inhibitor
- Reduces HbA1c by 0.5-0.7%
- Low risk of hypoglycemia
- Once daily oral tablet
Tradjenta (Linagliptin)
DPP-4 Inhibitor
- Reduces HbA1c by 0.5-0.8%
- Low risk of hypoglycemia
- Once daily oral tablet
Farxiga (Dapagliflozin)
SGLT2 Inhibitor
- Greater weight loss
- Cardiovascular benefits
- Risk of genital infections
Victoza (Liraglutide)
GLP-1 Receptor Agonist
- Greater HbA1c reduction
- Heart failure benefits
- Daily injection required
Comparison Results
Select two drugs above to see detailed comparison
Key Takeaways
- Onglyza (saxagliptin) is a once‑daily DPP‑4 inhibitor approved for type 2 diabetes.
- It lowers HbA1c by about 0.5‑0.8% and has a low risk of hypoglycaemia when used alone.
- Compared with other DPP‑4 inhibitors (Januvia, Tradjenta) it offers similar efficacy but a slightly higher cost in the UK.
- SGLT2 inhibitors such as Farxiga provide greater weight loss and cardiovascular benefits, but carry a risk of genital infections.
- Choosing the right drug hinges on patient‑specific factors like kidney function, cardiovascular history, and cost considerations.
When treating type 2 diabetes, Onglyza is a DPP‑4 inhibitor whose active ingredient is saxagliptin. It was approved by the FDA in 2015 and works by inhibiting the enzyme dipeptidyl peptidase‑4, which increases insulin secretion and reduces glucagon after meals. In the UK, the National Health Service (NHS) lists it as a second‑line option after metformin.
Metformin is the first‑line oral medication for type 2 diabetes. It lowers hepatic glucose production and improves insulin sensitivity, typically reducing HbA1c by 1‑1.5%.
Other DPP‑4 inhibitors you’ll often see on prescriptions include Januvia (sitagliptin) and Tradjenta (linagliptin). Both share the same mechanism as Onglyza but differ slightly in dosing frequency and renal clearance.
Beyond the DPP‑4 class, many clinicians consider Farxiga (dapagliflozin), an SGLT2 inhibitor, for patients who need weight loss or cardiovascular protection. Victoza (liraglutide), a GLP‑1 receptor agonist, offers even greater HbA1c reductions and proven heart‑failure benefits, though it requires daily injections.
How Onglyza Works - Mechanism and Pharmacology
The DPP‑4 enzyme breaks down incretin hormones (GLP‑1 and GIP) that stimulate insulin release after eating. By blocking DPP‑4, saxagliptin maintains higher incretin levels, leading to a modest increase in insulin and a reduction in post‑prandial glucose. This effect is glucose‑dependent, meaning the drug rarely causes low blood sugar unless combined with sulfonylureas or insulin.
Key pharmacokinetic facts:
- Oral tablet, 5mg once daily.
- Absorption is quick; peak plasma concentration occurs in ~2hours.
- Metabolized primarily via CYP3A4; dose adjustment is needed with strong CYP3A inhibitors.
- Elimination half‑life ~12hours, suitable for once‑daily dosing.
Clinical Efficacy - How Much Does It Lower Blood Sugar?
In head‑to‑head trials, Onglyza reduced HbA1c by an average of 0.6‑0.8% when added to metformin. This is comparable to Januvia (0.5‑0.7%) and Tradjenta (0.5‑0.8%).
When you stack a DPP‑4 inhibitor with metformin, the combined HbA1c reduction often reaches 1.2‑1.5%, enough to meet most target goals (<7% for most adults). For patients with a starting HbA1c above 9%, clinicians may opt for a more potent agent like an SGLT2 inhibitor or GLP‑1 agonist to achieve quicker results.
Safety Profile - What Side Effects Should You Watch?
Common adverse events for Onglyza include:
- Upper respiratory tract infection (≈5%).
- Headache (≈4%).
- Diarrhoea (≈3%).
Serious concerns are rare but worth noting:
- Heart failure hospitalization: post‑marketing data indicated a slight increase in patients with existing cardiac disease. The FDA added a boxed warning in 2022.
- Pancreatitis: reported in <0.1% of users; clinicians should stop the drug if symptoms arise.
In contrast, Farxiga frequently causes genital mycotic infections (≈8‑10%) and can lead to dehydration. Victoza often causes nausea (≈15%) but provides cardiovascular mortality reduction.
Cost Considerations - What Will It Actually Cost in 2025?
Pricing varies by pharmacy and insurance coverage. As of October2025, the estimated NHS price per 30‑day supply is:
| Drug | Mechanism | Typical Dose | Avg. Cost / month (£) |
|---|---|---|---|
| Onglyza | DPP‑4 inhibitor | 5mg once daily | £45 |
| Januvia | DPP‑4 inhibitor | 100mg once daily | £42 |
| Tradjenta | DPP‑4 inhibitor | 5mg once daily | £40 |
| Farxiga | SGLT2 inhibitor | 10mg once daily | £55 |
| Victoza | GLP‑1 receptor agonist | 0.6mg daily injection | £120 |
For patients with a private prescription, Onglyza’s cost can be offset by NHS prescription pre‑payment certificates or manufacturer patient‑access schemes.
When to Choose Onglyza - Ideal Patient Profiles
Onglyza shines in the following scenarios:
- Moderate HbA1c elevation (7‑9%) where metformin alone isn’t enough.
- Renal impairment - saxagliptin requires no dose reduction down to an eGFR of 30mL/min/1.73m², unlike some SGLT2 inhibitors.
- Low hypoglycaemia risk - ideal for older adults or those on sulfonylureas where added hypoglycaemia is undesirable.
- Weight neutrality - patients who can’t tolerate the weight loss associated with SGLT2 inhibitors or GLP‑1 agonists.
If a patient has established cardiovascular disease, an SGLT2 inhibitor (e.g., Farxiga) or GLP‑1 agonist (e.g., Victoza) may be preferred because they have proven heart‑failure and mortality benefits beyond glucose control.
Alternatives Overview - Quick Reference
Below is a concise side‑by‑side look at the most common alternatives to Onglyza.
| Drug | HbA1c Reduction | Weight Effect | Major Safety Concern | Administration |
|---|---|---|---|---|
| Onglyza | ‑0.6% to ‑0.8% | Neutral | Heart‑failure warning | Oral tablet |
| Januvia | ‑0.5% to ‑0.7% | Neutral | Rare pancreatitis | Oral tablet |
| Tradjenta | ‑0.5% to ‑0.8% | Neutral | Low renal clearance (good for kidney disease) | Oral tablet |
| Farxiga | ‑0.8% to ‑1.0% | ‑2kg average loss | Genital infections, dehydration | Oral tablet |
| Victoza | ‑1.0% to ‑1.5% | ‑3kg average loss | Nausea, possible gallbladder disease | Daily injection |
Practical Tips for Switching or Adding Onglyza
If you’re already on a sulfonylurea and your doctor wants to add Onglyza, consider the following steps:
- Check your latest HbA1c and renal function (eGFR).
- Start saxagliptin 5mg once daily with breakfast.
- Maintain the sulfonylurea dose for the first 2 weeks, then monitor for hypoglycaemia.
- If low blood sugars occur, reduce the sulfonylurea by 25‑50%.
- Re‑measure HbA1c after 12 weeks to assess effectiveness.
For patients moving from another DPP‑4 inhibitor, a simple transition is possible because all share the same once‑daily oral format; no washout period is needed.
Potential Pitfalls - What to Avoid
Common mistakes when prescribing or taking Onglyza include:
- Combining with strong CYP3A4 inhibitors (e.g., clarithromycin) without dose adjustment, leading to higher saxagliptin levels.
- Prescribing to patients with uncontrolled heart failure - the drug may worsen symptoms.
- Assuming weight loss will occur; Onglyza is weight‑neutral, so set realistic expectations.
Always review the patient’s medication list for possible drug-drug interactions before starting.
Bottom Line - Summarising the Choice
If you need a modest HbA1c drop, have concerns about hypoglycaemia, and want a pill you can take once a day, Onglyza fits the bill. However, if cardiovascular protection, weight loss, or a stronger glucose‑lowering effect is a priority, an SGLT2 inhibitor like Farxiga or a GLP‑1 agonist like Victoza may be a better fit, despite higher price or injection requirement.
Frequently Asked Questions
Can I take Onglyza if I have kidney disease?
Yes, Onglyza can be used down to an eGFR of 30mL/min/1.73m² without dose adjustment. Below that level, doctors usually switch to a drug with minimal renal clearance, such as Tradjenta.
How does Onglyza compare to Farxiga in lowering HbA1c?
Farxiga generally reduces HbA1c by 0.8‑1.0% and also promotes weight loss, while Onglyza offers a 0.6‑0.8% reduction with no weight change. Choose Farxiga if weight loss or cardiovascular benefit matters, but watch for genital infections.
Is there a risk of low blood sugar with Onglyza?
On its own, Onglyza has a very low hypoglycaemia risk because its glucose‑lowering effect depends on meal‑related glucose spikes. The risk rises only when combined with insulin or sulfonylureas.
What should I do if I experience a heart‑failure symptom while on Onglyza?
Stop the medication immediately and contact your healthcare provider. The FDA warning advises careful monitoring and often switching to a different class, such as an SGLT2 inhibitor with proven heart‑failure benefits.
Can I take Onglyza with my current metformin regimen?
Yes, the typical combination is metformin (500‑1000mg twice daily) plus Onglyza 5mg once daily. This duo often brings the total HbA1c reduction to about 1.2‑1.5%.
Alex Iosa
October 10, 2025 AT 01:47