Qtern (Saxagliptin and Dapagliflozin) - Oral

What Is Qtern?

Qtern (saxagliptin and dapagliflozin) is an oral prescription drug used along with diet and exercise to improve blood sugar control in adults with type 2 diabetes. Qtern is available as a tablet that is taken by mouth.

Qtern contains two ingredients in each tablet. The first ingredient, dapagliflozin, is categorized in a drug class called sodium-glucose cotransporter 2 (SGLT2) inhibitors. It works by helping the kidneys eliminate sugar through the urine. This helps lower blood sugar levels. The second ingredient, saxagliptin, is in a drug class called dipeptidyl peptidase-4 (DPP-4) inhibitors. It works by increasing the amount of insulin the body makes after meals when blood sugar is high. Insulin helps to lower blood sugar.

Drug Facts

Generic Name: Saxagliptin and dapagliflozin

Brand Name(s): Qtern

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: SGLT2 inhibitor/DPP-4 inhibitor

Available Generically: No

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Saxagliptin and dapagliflozin

Dosage Form(s): Tablet

What Is Qtern Used For?

The Food and Drug Administration (FDA) approved Qtern to improve blood sugar control in adults with type 2 diabetes. Qtern should be used along with diet and exercise. It is not approved for people with type 1 diabetes.

Qtern (Saxagliptin and Dapagliflozin) Drug Information: Kidneys and pancreas of a person

How to Take Qtern

If you are prescribed Qtern, read the prescription label and the information leaflet that comes with your prescription. Consult your healthcare provider if you have any questions. Use Qtern exactly as directed by your healthcare provider and do not skip doses. While on this medication, follow your healthcare provider's recommendations for diet and exercise.

Take Qtern once daily in the morning with or without food. It's important to swallow the tablet whole. Do not crush, chew, or cut the tablet.

Notify your healthcare provider if you are sick or having surgery. Before you start Qtern and during treatment, you may need blood work to test your kidney function. Your healthcare provider will also check your blood sugar and your hemoglobin A1C levels. Hemoglobin A1C is a measure of blood sugar control over three months. While on this medication, your urine will test positive for glucose, so another measure should be used to test sugar control, such as blood sugar. Follow your healthcare provider's instructions for testing blood sugar at home, how to treat low blood sugar (hypoglycemia), and what to do in the case of a high blood sugar reading.

Ask your healthcare provider if you have any questions or concerns about Qtern.

Storage

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

How Long Does Qtern Take to Work?

It may take up to a few weeks to see changes in blood sugar. Your healthcare provider will check your A1C at three months, where you will likely know if your blood sugar control has improved.

What Are the Side Effects of Qtern?

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 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 Qtern are:

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. 
  • Kidney problems/kidney failure
  • Ketoacidosis: This occurs when too much acid is in the blood and requires immediate medical attention. Symptoms include nausea, vomiting, stomach pain, confusion, drowsiness, or difficulty breathing.
  • Low blood sugar: Talk to your healthcare provider about how and when to test blood sugar and treat low blood sugar. Symptoms of blood sugar may include hunger, dizziness, and shakiness. You may also feel irritable, confused, or anxious.
  • Serious UTI: Call your healthcare provider if you have more frequent urination, pain or burning when you go to the bathroom, blood in the urine, or pain in the pelvis or back.
  • Heart failure: Get medical help if you have fast weight gain, shortness of breath, and swelling around the legs, feet, and ankles.
  • Inflamed pancreas (pancreatitis): Get medical help right away if you have nausea, vomiting, fast heart rate, and severe upper stomach pain that spreads to the back. Pancreatitis can be painful and can cause death.
  • Orthostatic hypotension: This can occur when your blood pressure drops quickly, and you feel dizzy going from sitting or lying down to standing. Qtern can cause dehydration, leading to feelings of dizziness and weakness. Stand up slowly and hold on to something sturdy for support. Report these symptoms to your healthcare provider.
  • Skin exfoliation: Get medical help right away if you have blistering, itching, or breakdown of the outer layer of skin.
  • Severe joint pain: Report symptoms to your healthcare provider.
  • Bullous pemphigoid: One of the ingredients in Qtern, saxagliptin, can cause this skin reaction that may require hospitalization. Call your healthcare provider right away if you get blisters or the breakdown of the skin's outer layer.
  • Fournier gangrene: This is an infection around the penis or vagina that can quickly become life-threatening. Get emergency medical help if you have a fever, are not feeling well, and have burning, itching, odor, discharge, pain, redness, or swelling around the genitals or rectal area.
  • Rhabdomyolysis: This is a breakdown in muscle tissue that can cause kidney damage. Get medical help right away if you have muscle pain, weakness, less urine, or dark and reddish urine.

Long-Term Side Effects

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

  • Sore throat
  • Sinus infection
  • Flu
  • Back or joint pain

Moderate long-term side effects can include:

Severe long-term side effects may include:

  • Kidney failure
  • Inflammation of the pancreas 
  • New malignancy (cancer)
  • Serious skin reactions
  • Heart failure
  • Diabetic ketoacidosis
  • Rhabdomyolysis
  • Bone fractures
  • Fournier gangrene

Report Side Effects

Qtern 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 Qtern Should I Take?

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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 once a day, taken in the morning. Each tablet contains 5 milligrams (mg) saxagliptin and 5 mg dapagliflozin or 5 mg saxagliptin and 10 mg dapagliflozin. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.

Modifications

Before using Qtern, talk to your healthcare provider about any current medical conditions.

You may need to use caution when taking Qtern if you are 65 or older, especially if you have low blood pressure or are at risk of low blood pressure or kidney problems. Qtern should not be used by people who have moderate to severe kidney problems (eGFR less than 45), end-stage renal disease (ESRD), or who are on dialysis. Qtern has not been studied in people with liver problems. It is also not approved for use in children or teenagers under 18.

Qtern should not be used during the second and third trimesters of pregnancy or if you are breastfeeding. Consult your healthcare provider if you are pregnant, planning to become pregnant, or are breastfeeding.

Missed Dose

If you miss a dose of Qtern, 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 at the same time.

Overdose: What Happens If I Take Too Much Qtern?

Taking too much Qtern can cause low blood sugar, which can be life-threatening. Symptoms of low blood sugar can include:

  • Weakness
  • Confusion
  • Shaking
  • Sweating
  • Fast heart rate and breathing
  • Difficulty speaking
  • Nausea
  • Vomiting
  • Fainting
  • Seizures

What Happens If I Overdose on Qtern?

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

If someone collapses, has a seizure or difficulty speaking, or can’t breathe or wake up after taking Qtern, call 911.

Precautions

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It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine. Blood and urine tests may be needed to check for unwanted effects.

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

If you are rapidly gaining weight, having 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.

Dizziness, lightheadedness, or fainting may occur with this medicine. This is more common if you have kidney disease, low blood pressure, or if you are taking a diuretic (water pill). Taking plenty of fluids each day may help. Drink plenty of water during exercise or in hot weather. Check with your doctor if you have severe nausea, vomiting, or diarrhea that does not stop. This may cause you to lose too much water.

Ketoacidosis (high ketones and acid in the blood) may occur while you are using this medicine. This can be life-threatening and requires immediate medical attention. Your doctor may give you insulin, fluid, and carbohydrate replacement to treat this condition. Tell your doctor right away if you have nausea, vomiting, trouble breathing, increased thirst or urination, or stomach pain.

Tell your doctor if you have bloody urine, decrease in how much or how often you urinate, painful or difficult urination, lower back or side pain, fever, chills, rapid weight gain, or swelling of the face, finger, or lower legs. These may be symptoms of a serious kidney problem.

This medicine may increase risk of having urinary tract infections, including pyelonephritis or urosepsis. Check with your doctor right away if you have bladder pain, bloody or cloudy urine, difficult, burning, or painful urination, or lower back or side pain.

This medicine may cause vaginal yeast infections in women and yeast infections of the penis in men. This is more common in patients who have a history of genital yeast infections or in men who are not circumcised. Women may have a vaginal discharge, itching, or odor. Men may have redness, itching, swelling, or pain around the penis, or a discharge with a strong odor from the penis. Check with your doctor right away if you have any of these symptoms.

This medicine may cause a rare but serious bacterial infection, called necrotizing fasciitis of the perineum or Fournier's gangrene, which can cause damage to the tissue under the skin in the area between and around the anus and genitals (perineum). Fournier's gangrene may lead to hospitalization, multiple surgeries, or death. Check with your doctor right away if you have fever, unusual tiredness or weakness, or pain, tenderness, redness, or swelling of the area between and around your anus and genitals.

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.

This medicine may cause serious allergic reactions, including anaphylaxis, angioedema, or certain skin conditions. 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.

This medicine may cause severe joint pain. Call your doctor right away if you have severe joint pain with this medicine.

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

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine for at least 3 days before you have surgery. This medicine may affect the results of certain medical tests (eg, urine glucose tests may not be accurate).

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 Qtern?

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

Others who should not take Qtern include:

  • People in the second or third trimester of pregnancy
  • People with type 1 diabetes or diabetic ketoacidosis
  • People with bladder cancer
  • People who are volume-depleted or dehydrated
  • People with severe kidney problems

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

  • People who take a medication that can harm the kidneys
  • People with low blood pressure or heart failure
  • Older adults
  • People at risk for ketoacidosis
  • People with pancreatic insulin deficiency (when the pancreas does not make enough insulin or does not use insulin properly)
  • People at risk of pancreatitis (inflammation of the pancreas)
  • People who have been fasting due to illness or surgery
  • People with alcohol use disorder
  • People with a history of genital fungal infections
  • Uncircumcised males

What Other Medications May Interact With Qtern?

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines and vitamins or supplements. 

Certain drugs known as strong CYP3A4 inhibitors interfere with drug metabolism (how the body processes the drug). In this case, potent CYP3A4 inhibitors should not be taken in combination with Qtern because they increase saxagliptin levels (one of the ingredients in Qtern) in the body. Examples of strong CYP3A4 inhibitors include:

  • Biaxin (clarithromycin)
  • Invirase (saquinavir)
  • Nizoral (ketoconazole)
  • Norvir (ritonavir) or combination drugs that contain ritonavir
  • Reyataz (atazanavir) or Evotaz (atazanavir/cobicistat)
  • Sporanox (itraconazole)

It is also important to note that SGLT2 inhibitors, such as dapagliflozin in Qtern, increase glucose excreted in the urine. Therefore, Qtern can lead to positive urine glucose tests. You should use urine testing to measure glucose (sugar levels) if you take this medication.

You should also avoid alcohol while taking Qtern. The combination of Qtern with alcohol could lower blood pressure and cause low blood sugar.

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

What Medications Are Similar?

Qtern contains two ingredients: dapagliflozin and saxagliptin. Dapagliflozin is an SGLT2 inhibitor. Drugs in the same class as dapagliflozin include:

  • Farxiga (dapagliflozin)
  • Invokana (canagliflozin)
  • Jardiance (empagliflozin)
  • Steglatro (ertugliflozin)

Saxagliptin is a DPP-4 inhibitor. Drugs in this class include:

  • Januvia (sitagliptin)
  • Nesina (alogliptin)
  • Onglyza (saxagliptin)
  • Tradjenta (linagliptin)

Like Qtern, many combination products contain two or more ingredients to help control blood sugar in adults with type 2 diabetes. Some examples include:

  • Glyxambi (empagliflozin and linagliptin)
  • Invokamet (canagliflozin and metformin)
  • Janumet (sitagliptin and metformin)
  • Jentadueto (linagliptin and metformin)
  • Kazano (alogliptin and metformin)

Examples of other oral medications that help control blood sugar in adults with type 2 diabetes include:

  • Glinides: Prandin (repaglinide), Starlix (nateglinide)
  • Glucophage (metformin)
  • Sulfonylureas: Amaryl (glimepiride), Glucotrol (glipizide), Micronase (glyburide) 
  • Thiazolidinedione: Actos (pioglitazone)

Some people with type 2 diabetes use injectable medications that help control blood glucose levels. These drugs are not insulin. They are part of a class called glucagon-like peptide-1 (GLP-1) agonists and include:

  • Ozempic (semaglutide)
  • Saxenda (liraglutide)
  • Trulicity (dulaglutide)
  • Victoza (liraglutide).

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

Some people with type 2 diabetes also need injectable insulin to help control blood sugar. There are different types of short-acting insulin and long-acting insulin. Some examples of short-acting insulin are Humalog and Novolog. Examples of long-acting insulin are Lantus and Levemir.  

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

Frequently Asked Questions

  • What is Qtern used for?

    Qtern is used along with diet and exercise to help control blood sugar in adults with type 2 diabetes.

  • How does Qtern work?

    Qtern contains two drugs in one pill: dapagliflozin and saxagliptin. Dapagliflozin helps the kidneys get rid of sugar in the urine. Saxagliptin increases the amount of insulin the body makes after meals.

  • What drugs should not be taken with Qtern?

    Qtern should not be taken with drugs that are classified as strong CYP3A4 inhibitors. Examples of these drugs include Biaxin (clarithromycin), Nizoral (ketoconazole), and Sporanox (itraconazole).

  • How long does it take for Qtern to work?

    It may take a week or several weeks to see changes in blood sugar. Your healthcare provider will check your hemoglobin A1C at three months, where it is likely that you will see your blood sugar control has improved.

  • What are the side effects of Qtern?

    Common side effects may include upper respiratory infection, urinary tract infection, headache, low blood sugar, diarrhea, back and joint pain, genital fungal infection, and increased cholesterol. Other, more serious side effects may occur as well. Before taking Qtern, talk with your healthcare provider about what side effects to expect and how to address them.

  • How do I stop taking Qtern?

    Take Qtern daily as directed by your healthcare provider. Your healthcare provider will tell you how long to take it. Do not stop your treatment regimen without consulting your healthcare team first.

How Can I Stay Healthy While Taking Qtern?

Before taking Qtern, talk about your medical history and the medications you take with your healthcare provider. While taking your treatment, follow your healthcare provider’s instructions for use. Read the patient information that comes with your prescription, and consult the healthcare team t if you have any questions or concerns.

Ask your healthcare provider if you should carry glucagon with you. Glucagon can be used if you have a severe low blood sugar emergency (when you are unable to eat or drink) to increase your blood sugar. Glucagon is available by injection, or a nasal spray called Baqsimi. Learn how to use the glucagon you are prescribed, and ensure your loved ones or caregivers know how to use it in an emergency. 

Qtern should be used along with diet and exercise to help control blood sugar. Your healthcare provider can recommend a diet and exercise plan. A registered dietician may be a helpful resource in mapping out dietary changes. Avoid drinking alcohol during your treatment, as the combination could lower blood pressure and cause low blood sugar. 

Qtern can cause low blood pressure. You may feel dizzy when standing up from lying down or sitting down. Stand up slowly and hold on to something sturdy for support. Report these symptoms to your healthcare provider if they occur. In older adults, this could increase the risk of falls and fractures.

Your healthcare provider will instruct you on how and when to check your blood sugar. Ask if your healthcare provider’s office has a certified diabetes care and education specialist (CDCES) who can demonstrate how to use your meter and answer other questions about type 2 diabetes.  

Purchase a medical alert, such as a bracelet or necklace, and wear it at all times. This alerts responders that you have type 2 diabetes in the event of an emergency. 

Keep essential items together, so you can take them wherever you go. Many people find it helpful to prepare a diabetes bag with supplies. Some things you may want to include are:

  • Blood glucose testing meter and extra supplies (e.g., strips, lancing device, lancets, alcohol wipes, and an extra set of batteries)
  • Emergency contact information
  • Glucagon for emergency use
  • Low blood sugar treatments (e.g., juice boxes, glucose tablets, and Smarties)

Medical Disclaimer

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

6 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. Food and Drug Administration. Qtern label.

  2. Food and Drug Administration. Qtern label.

  3. Epocrates. Qtern.

  4. Prescribers’ Digital Reference. Dapagliflozin/saxagliptin - drug summary.

  5. DailyMed. Qtern - dapagliflozin and saxagliptin tablet, film coated.

  6. Epocrates. Qtern.

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