Nesina, Kazano, and Oseni

Dr K. here, your online diabetes pharmacist, and I’d like to talk to you today about another diabetic medication.  A few weeks ago when I was at work, I received a phone call from a drug company.  This is not uncommon in the pharmacy – manufacturers like to call and make sure we are aware of their products and that we are stocking them.  The phone call this particular day was about a medication that I had not heard of – Nesina.  When the representative on the phone informed me that Nesina is a medication used for Type 2 diabetes, my ears perked up.  I might not have been aware of Nesina (which was approved in January of this year), but I am very familiar with the family of medications that it belongs to, the DPP-4 Inhibitors.  Other DPP-4 Inhibitors include Onglyza, Januvia, and Trajenta.  If you want an overview of the DPP-4 Inhibitor class, or any of the other classes of diabetes medications, you can read about them all on my previous post here.

Nesina is also available in a tablet combined with metformin (this combination tablet is known as Kazano) and also a tablet combined with Actos (this combination is known as Oseni).  Since I’ve already discussed metformin and Actos, I won’t be talking about the combination pills here, but I will talk about the Nesina part of the pill in this post.  You can refer to my other posts on metformin and Actos if you are taking one of these combination pills.

How does it lower blood sugar: Nesina is a DPP-4 inhibitor, which means it inhibits, or hinders, a protein in the body called DPP-4.  The name “DPP-4” isn’t important, but some really exciting stuff happens when drugs like Nesina start getting in the way when DPP-4 is trying to do its job.  When DPP-4 is blocked, the body is able to produce more insulin, the substance in your body that helps to “open the door” for glucose to enter your cells.  Also, DPP-4 inhibitors help to slow down the production of glucagon.  Remember, glucagon helps the body release glucose into the blood from where it is being stored, causing an increase in blood sugars.  By increasing insulin and decreasing glucagon, your blood sugars go down.

The effect on your numbers: From the studies I’ve seen, patients on Nesina by itself could see anywhere from a 0.6 to 1% drop in their A1c after 26 weeks (meaning a patient could go from an A1c of 9.6 to an A1c of 8.6 to 9.0.  Nesina does not appear to cause weight gain or weight loss.

Dosing: Nesina is taken once daily and can be taken with or without food.  The normal dose is 25 mg, but your dose might be lowered if you have kidney problems.

Side effects: The most common side effects, seen in more than 4% of patients, are headache, upper respiratory infection, and nasopharyngitis (inflammation in the nose and throat).  There are a few serious side effects that have been linked to Nesina.  Some patients have reported allergic reactions to the drug, swelling of the throat or face, liver failure, and a severe rash called Stevens-Johnson syndrome.

But the most major possible side effect of Nesina is pancreatitis (inflammation of the pancreas), which is seen in about 0.2% of patients on Nesina.  This can be very severe, and may lead to death.  Some patients are more at risk for this than others, so you should talk to your doctor about this if you are on Nesina, or starting it for the first time.  A sign of possible pancreatitis is severe stomach pain that does not go away.  This pain can be felt in the back as well.  You may or may not vomit with pancreatitis.  If you experience these symptoms, let your doctor know right away.

Who should not take Nesina: If you have taken another DPP-4 Inhibitor for diabetes (like Januvia, Onglyza, or Trajenta) and have had a serious reaction to it, Nesina might cause the same reaction, so you might want to try another type of medication instead.  For patients with kidney problems, sometimes a lower dose can be used; if you have kidney failure, Nesina is not the best option for you.  Nesina can cause liver and pancreas problems, so your doctor will be watching for this and will try another med if they think the problems have been caused by Nesina.  There is no real evidence that Nesina causes risk during pregnancy or breastfeeding, but the risks cannot be ruled out because there might not be enough studies on it at this point.  If you are pregnant, considering becoming pregnant, or are breastfeeding, let your doctor know so that you can make the right decision for you and your child.

Drug interactions: There are no major drug interactions with Nesina that I am aware of, but there are more minor interactions that your local doctor or pharmacist can inform you of if you start taking Nesina.  If Nesina is used along with insulin or a sulfonylurea (glyburide, glipizide, glimepiride), it can cause your blood sugars to drop dangerously low, so your doctor may need to lower your insulin or sulfonylurea dose when starting Nesina to prevent this.

Monitoring: When you are on Nesina, you should check your blood sugar daily and watch for signs of low blood sugar.  Your doctor will be doing A1c tests to see how well you are doing in your fight against diabetes.  Your doctor will want to be watching your blood work as well to see how your liver and kidneys are doing.  And of course, be watching for those signs of pancreatitis (severe abdominal pain).

Place in therapy for diabetes: Nesina is not one of the most common medications used for type 2 diabetes because of the cost, the newness, and the fact that there are other medications just like it that are a bit older and more established.  A study in 2011 looked at adding Nesina to patients who were already on metformin and Actos and who were still having problems with their blood sugars.  They found that adding Nesina caused a bigger drop in A1c than if they had not used Nesina and had just increased the dose of Actos.  So it looks as if Nesina might be a good option for adding on if you are already on metformin and Actos and are still having a high A1c.  Of course, your doctor will be the one to determine if this is an option for you.

If you would like to learn more about Nesina and the combination pills Kazano and Oseni, you can read more about them here.

As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions.  However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs.  Remember to always check with your medical provider and pharmacist before stopping or starting any new medications.  My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health.  Please consult with your doctor and pharmacist about anything regarding your health.

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