June 27, 2016
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Nesina Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 10/6/2015

Nesina (alogliptin) is an anti-diabetic drug used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Nesina should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Common side effects of Nesina include cold symptoms (stuffy nose, sore throat, sinus infection, sinus pain), or headache.

The recommended dose of Nesina is 25 mg once daily. Nesina may interact with other drugs. Tell your doctor all medications and supplements you use. Tell your doctor if you are pregnant or plan to become pregnant before taking Nesina. It is unknown if this drug passes into breast milk. Consult your doctor before breastfeeding.

Our Nesina (alogliptin) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information in Detail?

Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.

Nesina in Detail - Patient Information: Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using alogliptin and call your doctor at once if you have:

  • severe pain in your upper stomach spreading to your back;
  • nausea and vomiting, loss of appetite, fast heart rate;
  • itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • headache; or
  • cold symptoms such as stuffy nose, sinus pain, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Nesina (Alogliptin Tablets)

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Nesina FDA Prescribing Information: Side Effects
(Adverse Reactions)


Clinical Studies Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Approximately 8500 patients with type 2 diabetes have been treated with NESINA in 14 randomized, double-blind, controlled clinical trials with approximately 2900 subjects randomized to placebo and approximately 2200 to an active comparator. The mean exposure to NESINA was 40 weeks with more than 2400 subjects treated for more than one year. Among these patients, 63% had a history of hypertension, 51% had a history of dyslipidemia, 25% had a history of myocardial infarction, 8% had a history of unstable angina and 7% had a history of congestive heart failure. The mean duration of diabetes was seven years, the mean body mass index (BMI) was 31 kg/m² (51% of patients had a BMI ≥ 30 kg/m²), and the mean age was 57 years (24% of patients ≥ 65 years of age).

Two placebo-controlled monotherapy trials of 12 and 26 weeks of duration were conducted in patients treated with NESINA 12.5 mg daily, NESINA 25 mg daily and placebo.

Four placebo-controlled add-on combination therapy trials of 26 weeks duration were also conducted: with metformin, with a sulfonylurea, with a thiazolidinedione and with insulin. Four placebo-controlled and one active-controlled trials of 16 weeks up through two years in duration were conducted in combination with metformin, in combination with pioglitazone and with pioglitazone added to a background of metformin therapy.

Three active-controlled trials of 52 weeks in duration were conducted in patients treated with pioglitazone and metformin, in combination with metformin and as monotherapy compared to glipizide.

In a pooled analysis of these 14 controlled clinical trials, the overall incidence of adverse events was 66% in patients treated with NESINA 25 mg compared to 62% with placebo and 70% with active comparator. Overall discontinuation of therapy due to adverse events was 4.7% with NESINA 25 mg compared to 4.5% with placebo or 6.2% with active comparator.

Adverse reactions reported in ≥ 4% of patients treated with NESINA 25 mg and more frequently than in patients who received placebo are summarized in Table 1.

Table 1: Adverse Reactions Reported in ≥ 4% Patients Treated with NESINA 25 mg and More Frequently Than in Patients Given Placebo in Pooled Studies

  Number of Patients (%)
NESINA 25 mg
Active Comparator
Nasopharyngitis 257 (4.4) 89 (3.0) 113 (5.0)
Headache 247 (4.2) 72 (2.5) 121 (5.4)
Upper Respiratory Tract Infection 247 (4.2) 61 (2.1) 113 (5.0)


In the clinical trial program, pancreatitis was reported in 11 of 5902 (0.2%) patients receiving NESINA 25 mg daily compared to five of 5183 ( < 0.1%) patients receiving all comparators.

Hypersensitivity Reactions

In a pooled analysis, the overall incidence of hypersensitivity reactions was 0.6% with NESINA 25 mg compared to 0.8% with all comparators. A single event of serum sickness was reported in a patient treated with NESINA 25 mg.


Hypoglycemic events were documented based upon a blood glucose value and/or clinical signs and symptoms of hypoglycemia.

In the monotherapy study, the incidence of hypoglycemia was 1.5% in patients treated with NESINA compared to 1.6% with placebo. The use of NESINA as add-on therapy to glyburide or insulin did not increase the incidence of hypoglycemia compared to placebo. In a monotherapy study comparing NESINA to a sulfonylurea in elderly patients, the incidence of hypoglycemia was 5.4% with NESINA compared to 26% with glipizide (Table 2).

Table 2: Incidence and Rate of Hypoglycemia* in Placebo and Active-Controlled Studies when NESINA Was Used as Add-On Therapy to Glyburide, Insulin, Metformin, Pioglitazone or Compared to Glipizide

Add-On to Glyburide (26 Weeks) NESINA 25 mg + Glyburide Placebo + Glyburide
  N=198 N=99
Overall (%) 19 (9.6) 11 (11.1)
Severe (%)† 0 1 (1)
Add-On to Insulin (± Metformin) (26 Weeks) NESINA 25 mg + Insulin (± Metformin) Placebo + Insulin (± Metformin)
  N=129 N=129
Overall (%) 35 (27) 31 (24)
Severe (%)† 1 (0.8) 2 (1.6)
Add-On to Metformin (26 Weeks) NESINA 25 mg + Metformin Placebo + Metformin
  N=207 N=104
Overall (%) 0 3 (2.9)
Severe (%)† 0 0
Add-On to Pioglitazone (± Metformin or Sulfonylurea) (26 Weeks) NESINA 25 mg + Pioglitazone Placebo + Pioglitazone
  N=199 N=97
Overall (%) 14 (7.0) 5 (5.2)
Severe (%)† 0 1 (1)
Compared to Glipizide (52 Weeks) NESINA 25 mg Glipizide
  N=222 N=219
Overall (%) 12 (5.4) 57 (26)
Severe (%)† 0 3 (1.4)
Add-On to Metformin (26 Weeks) NESINA 25 mg Metformin 500 mg twice daily
  N=112 N=109
Overall (%) 2 (1.8) 2 (1.8)
Severe (%)† 0 0
Add-On to Metformin Compared to Glipizide (52 Weeks) NESINA 25 mg + Metformin Glipizide + Metformin
  N=877 N=869
Overall (%) 12 (1.4) 207 (23.8)
Severe (%)† 0 4 (0.5)
*Adverse reactions of hypoglycemia were based on all reports of symptomatic and asymptomatic hypoglycemia; a concurrent glucose measurement was not required; intent-totreat population.
†Severe events of hypoglycemia were defined as those events requiring medical assistance or exhibiting depressed level or loss of consciousness or seizure.

Vital Signs

No clinically meaningful changes in vital signs or in electrocardiograms were observed in patients treated with NESINA.

Laboratory Tests

No clinically meaningful changes in hematology, serum chemistry or urinalysis were observed in patients treated with NESINA.

Postmarketing Experience

The following adverse reactions have been identified during the postmarketing use of NESINA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria and severe cutaneous adverse reactions, including Stevens-Johnson syndrome, hepatic enzyme elevations, fulminant hepatic failure, severe and disabling arthralgia and acute pancreatitis [see WARNINGS AND PRECAUTIONS].

Read the entire FDA prescribing information for Nesina (Alogliptin Tablets)

Report Problems to the Food and Drug Administration


You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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