Kazano (Alogliptin and Metformin) - Oral

Warning:

Metformin, one of the ingredients in Kazano, has been associated with lactic acidosis. Lactic acidosis is a dangerous condition that can result in low blood pressure, slow heart rate, and death. Symptoms may include feeling unwell, muscle and stomach pain, dizziness, cold hands and feet, sleepiness, and severe shortness of breath. Certain people are at higher risk for lactic acidosis, including older adults (aged 65 and older), people who have kidney or liver problems, people who are undergoing studies with contrast or certain procedures, people who have consumed too much alcohol, and people who take certain medications at the same time as Kazano. If you have symptoms of lactic acidosis, stop taking Kazano and get emergency medical help. Lactic acidosis is a medical emergency and must be treated in the hospital.

What Is Kazano?

Kazano (alogliptin and metformin) is an oral prescription drug used alone or together with other medications and diet and exercise to improve blood sugar control in adults with type 2 diabetes.

Kazano is available as an oral tablet belonging to a drug class called dipeptidyl peptidase-4 (DDP-4) inhibitors/biguanides. Kazano contains two ingredients that work together to help improve blood sugar control.

Alogliptin is a DPP-4 inhibitor. It works by increasing the amount of insulin in the body, which helps control blood sugar. Metformin is a biguanide. It works by decreasing the amount of glucose (sugar) that the liver makes. It also reduces the amount of sugar you absorb from food and helps the body respond better to insulin.

Kazano is available by prescription in tablet form.

Drug Facts

Generic Name: Alogliptin and metformin

Brand Name(s): Kazano

Drug Availability: Prescription

Therapeutic Classification: Dipeptidyl peptidase-IV inhibitors/biguanides

Available Generically: Yes

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Alogliptin and metformin

Dosage Form(s): Tablet

What Is Kazano Used For?

The Food and Drug Administration (FDA) approved Kazano to improve blood sugar control in adults with type 2 diabetes inadequately controlled by metformin or are already being treated with alogliptin and metformin. It can also be used as part of triple combination therapy with pioglitazone and insulin. Use Kazano along with dietary and exercise measures.

Kazano is not indicated to treat type 1 diabetes or diabetic ketoacidosis (DKA). DKA is a life-threatening complication caused by a buildup of blood acids or ketones. DKA is more common in people with type 1 diabetes.

Kazano (Alogliptin and Metformin) Drug Information - Pancreas, Liver, and intestines on a person

Verywell / Dennis Madamba

How to Take Kazano

If you are prescribed Kazano, read the prescription label and the information leaflet that comes with your prescription. Use Kazano exactly as directed by your healthcare provider, and do not skip doses. Do not change your dose unless your healthcare provider tells you to do so. Consult your healthcare provider if you have any questions.

Take Kazano with food to lessen stomach-related side effects. Swallow the tablet whole with water; do not chew, crush, cut, or break the tablet to take it. In addition to taking your medication as prescribed, continue to follow a diet and exercise plan. Test your blood sugar as directed by your healthcare provider. They may check your blood sugar levels and your hemoglobin A1C, a measure of blood sugar control over three months, and order blood tests to monitor how your kidneys are working.

You should also tell your healthcare provider if you are sick or plan to have surgery. In this case, they may need to change the dose of your medication.

Storage

Store this medication at room temperature, away from heat, direct light, and moisture. Keep this medication in its original labeled container and out of reach and sight of children and pets. Keep the bottle tightly closed when not in use.

How Long Does Kazano Take to Work?

A single dose of Kazano should reach its highest levels in the body within two or three hours. It may take up to 14 days to see significant changes in blood sugar levels. At the three-month mark, the A1C test can show how blood sugar has been controlled over three months.

What Are the Side Effects of Kazano?

Like other medications, Kazano can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or prescribing healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects of Kazano are:

  • Cough and cold symptoms
  • Diarrhea
  • High blood pressure
  • Stomach problems, including nausea, vomiting, diarrhea, indigestion, discomfort, and gas
  • Appetite loss
  • Metallic taste in the mouth
  • Low blood sugar
  • Headache
  • Back pain
  • Weakness
  • Urinary tract infection (UTI)
  • Vitamin B12 deficiency
  • Rash
  • Ovulation induction (Kazano can stimulate ovulation, which can result in an unexpected pregnancy)

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention. 
  • Stevens-Johnson syndrome: A life-threatening skin reaction can have symptoms of red or purple rash, blistering or peeling skin, fever, burning eyes, and sore throat. Stevens-Johnson syndrome requires emergency medical attention.
  • Lactic acidosis: A life-threatening complication that requires emergency medical attention. Symptoms may include muscle pain, difficulty breathing, stomach pain, vomiting, slow heart rate, or feeling cold, dizzy, tired, lightheaded, or weak. Even if your symptoms seem mild, get emergency medical attention.
  • Liver failure: Symptoms may include nausea, upper stomach pain, appetite loss, dark urine, yellowing of the skin or whites of the eyes, and fatigue.
  • Heart failure: Symptoms may include shortness of breath, fast weight gain, or swelling in the legs and feet.
  • Inflammation of the pancreas: Call your healthcare provider right away if you have severe upper stomach pain that spreads to the back, nausea, vomiting, appetite loss, or fast heartbeat.
  • Low blood sugar: Your healthcare provider will instruct you on how and when to test your blood sugar and what to do in the event of low blood sugar.
  • Megaloblastic anemia: This occurs when the bone marrow produces very large blood cells that crowd out normal, healthy ones. Symptoms may include pale skin, tiredness, and appetite loss.
  • Severe joint pain
  • Bullous pemphigoid: A rare skin condition that can cause fluid-filled blisters on the
  • stomach, chest, arms, legs, groin, or armpits (or in the mouth as sores).
  • Rhabdomyolysis (muscle breakdown, which can cause severe kidney damage or death)

Long-Term Side Effects

While many people tolerate Kazano well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:

  • Infection
  • Sore throat
  • Appetite loss
  • Back and joint pain

Moderate long-term side effects can include: 

  • Vitamin B12 and folate deficiency
  • Increased liver enzymes
  • Liver problems
  • Metabolic acidosis (too much acid in the body): Symptoms can include tiredness, nausea, vomiting, and fast breathing.

Severe long-term side effects may include: 

  • Lactic acidosis
  • Stevens-Johnson syndrome
  • Inflammation of the pancreas
  • Megaloblastic anemia
  • Liver, heart, or kidney failure
  • Rhabdomyolysis
  • Pemphigus
  • Serum sickness (a reaction that can cause rash, fever, and muscle pain)

Report Side Effects

Kazano may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Kazano Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For type 2 diabetes:
      • Adults—At first, 1 tablet (either alogliptin 12.5 milligrams [mg] plus metformin 500 mg or alogliptin 12.5 mg plus metformin 1000 mg) 2 times a day with food. Your doctor may adjust your dose as needed. However, the dose is usually not more than alogliptin 25 mg plus metformin 2000 mg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

You may need to use caution when taking Kazano if you are 65 years or older, especially if you have kidney problems. Healthcare providers will generally start Kazano at a lower dose, increasing slowly if needed, and monitor kidney function frequently.

Kazano is only approved in adults. It is not approved in children and adolescents under 18 years old.

People with liver problems or severe kidney problems should not take Kazano.

Kazano may stimulate ovulation, which can result in pregnancy. Discuss effective means of birth control with your healthcare provider if pregnancy is not desired. There is little data on Kazano and pregnancy or breastfeeding. If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare provider.

Missed Dose

If you miss a dose of Kazano, take it as soon as you can. If it is almost time for the next dose, skip the missed dose. Do not take two doses together.

Overdose: What Happens If I Take Too Much Kazano?

Taking too much Kazano can cause low blood sugar or lactic acidosis.

What Happens If I Overdose on Kazano?

If you think you or someone else may have overdosed on Kazano, call your healthcare provider or the Poison Control Center (800-222-1222). 

If someone collapses or stops breathing after taking Kazano, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. Symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite, diarrhea, fast, shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness.

If symptoms of lactic acidosis occur, you should get immediate emergency medical help.

Pancreatitis (swelling and inflammation of the pancreas) may occur while you are using this medicine. Check with your doctor right away if you have a sudden and severe stomach pain, chills, constipation, nausea, vomiting, loss of appetite, fever, or lightheadedness.

If you are rapidly gaining weight, having shortness of breath, chest pain, extreme tiredness or weakness, irregular breathing, irregular heartbeat, or excessive swelling of the hands, wrist, ankles, or feet, check with your doctor immediately. These may be symptoms of a heart problem.

This medicine may cause serious allergic reactions, including anaphylaxis, angioedema, or certain skin conditions (eg, Stevens-Johnson syndrome). These reactions can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, blistering, peeling, or loosening of the skin, fever or chills, trouble breathing or swallowing, or any swelling of your hands, face, mouth, or throat while you are using this medicine.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause hypoglycemia (low blood sugar). This is more common when this medicine is taken together with certain medicines. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly. Talk to your doctor about the best way to treat low blood sugar.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar.

There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes with a list of all your medicines.

It is important to tell the doctor in charge that you are taking this medicine if you are going to have any medical or surgical procedures.

This medicine may cause severe and disabling joint pain. Call your doctor right away if you have severe joint pain while using this medicine.

This medicine may cause bullous pemphigoid. Tell your doctor right away if you have large, hard skin blisters while you are using this medicine.

This medicine may cause some women who do not have regular monthly periods to ovulate. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Kazano?

Kazano is not appropriate for everyone. You should not take this medication if you are allergic to alogliptin, metformin, or any of the inactive ingredients in Kazano.

Kazano should not be used in:

  • People with liver disease or severe kidney disease (eGFR less than 30)
  • People with type 1 diabetes or DKA
  • People with metabolic acidosis or lactic acidosis
  • People who are severely dehydrated
  • Stress conditions, such as severe infections or surgery
  • People with sepsis (a life-threatening infection that occurs when the body damages its own tissues in response to an infection)
  • People with hypoxemia (low oxygen levels, due to certain heart or lung conditions)
  • Pregnancy or while breastfeeding

Kazano may be prescribed with caution in some people, only if the healthcare provider determines it is safe. This includes:

  • Older adults (aged 65 and older)
  • People with heart failure
  • People with alcohol use disorder
  • Women who do not ovulate and are of childbearing age
  • People with kidney problems
  • People who are at risk for low blood sugar or heart failure

What Other Medications May Interact With Kazano?

Before taking Kazano, tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter drugs and vitamins or supplements. 

Alcohol can interact with Kazano, increasing the risk of low blood sugar. Talk to your healthcare provider about how much alcohol is safe to consume.

Drugs classified as carbonic anhydrase inhibitors can lead to lactic acidosis if combined with Kazano. Examples of these drugs include:

When Kazano is taken with insulin or other drugs that lower blood sugar, a dosage adjustment may be required to reduce the risk of low blood sugar.

Some drugs increase blood sugar, so when combined with Kazano, you may require careful monitoring to control blood sugar levels. Examples of these drugs include:

  • Calcium channel blockers, such as Calan SR (verapamil)
  • Corticosteroids, such as prednisone
  • Dilantin (phenytoin)
  • Diuretics such as Microzide (hydrochlorothiazide) or Lasix (furosemide)
  • Estrogen
  • Isoniazid
  • Oral birth control pills
  • Phenothiazines, such as prochlorperazine or thioridazine
  • Thyroid medications

Other drug interactions may occur with Kazano. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar to Kazano?

Kazano contains two ingredients: alogliptin and metformin. Alogliptin is a DPP-4 inhibitor. It is also available as a single-ingredient drug under the brand name Nesina.

Other DPP-4 inhibitors include:

Another drug containing alogliptin is Oseni, which includes two ingredients: alogliptin and pioglitazone.

Metformin can also be found as a single-ingredient drug under brand names, such as Glumetza and Glucophage. It is also available as an extended-release tablet (Glucophage XR).

Other oral medications available to help control blood sugar in adults with type 2 diabetes include:

  • Glinides, such as repaglinide and nateglinide
  • SGLT2 inhibitors, such as Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozin)
  • Sulfonylureas, such as Amaryl (glimepiride), Glucotrol (glipizide), Micronase (glyburide) 
  • Thiazolidinedione, such as Actos (pioglitazone)

There are also a variety of drugs that contain more than one ingredient, like Kazano.

Some people who have type 2 diabetes use injectable medications that are not insulin but can help control blood sugar. These drugs belong to a class called glucagon-like peptide-1 (GLP-1) agonists. Some examples of GLP-1 agonists are:

There is also an oral GLP-1 agonist available called Rybelsus (semaglutide). 

In some cases, people with type 2 diabetes may also need to use injectable insulin to help control blood sugar levels. There are different types of short-acting insulin and long-acting insulin.

This list is a list of drugs also prescribed for type 2 diabetes. It is NOT a list of drugs recommended to take with Kazano. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Kazano used for?

    Kazano is an oral medication that contains two ingredients: alogliptin and metformin. It is used along with diet and exercise to control blood sugar levels in adults with type 2 diabetes.

  • How does Kazano work?

    Kazano contains two ingredients. One ingredient, alogliptin, increases the amount of insulin in the body, helping to control blood sugar. The other ingredient, metformin, decreases the amount of sugar that your liver makes. Metformin also decreases how much sugar is absorbed from food and helps the body respond better to insulin.  

  • What drugs should not be taken with Kazano?

    Kazano can interact with certain drugs and alcohol (see interactions section for details). Before taking Kazano, talk to your healthcare provider about alcohol consumption and how much is safe for you. Tell them about all of your medications, including prescription and over-the-counter drugs, vitamins, and supplements.

  • How long does it take for Kazano to work?

    A dose of Kazano reaches its highest levels in the body within two to three hours. It may take up to two weeks to see significant changes in blood sugar levels. The healthcare provider will most likely order an A1C test about 90 days after starting Kazano to look at blood sugar control over three months.

  • What are the side effects of Kazano?

    Stomach problems, such as nausea, vomiting, diarrhea, discomfort, gas, and indigestion are common side effects of Kazano. Other common side effects include cough and cold symptoms, appetite loss, low blood sugar, headache, back pain, weakness, UTI, rash, and a metallic taste in the mouth. Kazano can stimulate ovulation, so women of childbearing age should discuss effective birth control with their healthcare provider if pregnancy is not desired.

    There are also some serious side effects, which are not common but require medical attention. People who experience symptoms of an allergic reaction, such as hives, difficulty breathing, or swelling around the face, lips, tongue, or throat, require emergency medical attention.

  • How do I stop taking Kazano?

    Your healthcare provider will advise you on how long to take Kazano. Do not stop taking the medication without guidance from your healthcare provider. 

How Can I Stay Healthy while Taking Kazano?

Before taking Kazano, discuss your medical history and all medication you take with your healthcare provider. Discuss alcohol use and safe amounts of alcohol consumption.

Follow your healthcare provider’s instructions on how to take Kazano. Carefully read the patient information about your prescription and talk to your healthcare team if you have any questions or concerns.

While taking Kazano, you may need to check your blood sugar. Ask your healthcare provider about the signs of low blood sugar, how to treat it, and how often you should check it. It can be helpful to prepare a diabetes kit or bag with supplies to take everywhere you go. You may want to include the following items:

  • Your blood sugar testing meter and extra supplies (e.g., strips, lancing device, lancets, alcohol wipes, batteries)
  • Emergency contact information
  • Glucagon (injection or nasal Baqsimi)
  • Low blood sugar treatments, such as glucose tablets and small juice boxes 

Wear a medical alert identification, such as a necklace or bracelet, at all times. This can alert responders that you have type 2 diabetes in the event of an emergency.

Kazano should be used along with diet and exercise to help improve blood sugar levels. Ask your healthcare provider about what diet and exercise regimen you should follow. You may want to see a registered dietician for help with dietary changes.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. DailyMed. Label: Kazano - alogliptin and metformin hydrochloride tablet, film coated.

  2. Takeda. Kazano monograph.

  3. DailyMed. Label: Kazano - alogliptin and metformin hydrochloride tablet, film coated.

  4. Prescriber's Digital Reference. Alogliptin/metformin hydrochloride - drug summary.

By Karen Berger, PharmD
Karen Berger, PharmD, is a community pharmacist and medical writer/reviewer.