Saxagliptin induced bilateral knee arthralgia: a rare case report

Akshay Dahiwele, Dinesh Kansal, Atal Sood, Dheeraj Kapoor, Parveen Sharma, Aradhna Sharma


A 55 year old female patient of type 2 diabetes mellitus on saxagliptin (5 mg once a day), a dipeptidyl peptidase 4 inhibitor (DPP-4 inhibitors) as add on therapy to metformin (1000 mg twice a day). After two months of addition of saxagliptin, the patient had pain in both the knee joints. Saxagliptin was withdrawn and then the knee pain was gradually relieved. Other cause of joint pains like osteoarthritis, rheumatoid arthritis, gout, septic arthritis etc. were ruled out. We consider that this case is important in bringing this potential side effect to the attention of both pharmacologists and primary care physicians as DPP- IV inhibitors has been the most commonly used drug substitute to glimepiride as an add on therapy to metformin.


Saxagliptin, Knee pain, Adverse drug reaction

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Powers AC, D’Alessio D. Endocrine pancreas and pharmacotherapy of diabetes melllitus and hypoglycemia. In: Brunton LL editor. Goodman and Gillmans The Pharmacological Basis of Therapeutics. 12th ed.

Dipeptidyl Peptidase-IV Inhibitors: Pharmacological Profile and Clinical Use. American Diabetes Association. Clinical Diabetes. 2008;26(2):53-7.

Information on Dipeptidyl Peptidase-4 (DPP-4) Inhibitors. Available at:

Onglyza. Highlights of prescribing information. Available at:

Symptoms and causes - knee pain - mayo clinic. Available at:

Companion J, Western A. Statins and joint pain. Br J Clin Pharmacol. 2008;66(4):570-1.

Cleocin hydrochloride: clindamycin hydrochloride capsule Pharmacia and Upjohn Company. Available at: drugsatfda_docs/label/2009/050162s085lbl.pdf.

ULORIC (febuxostat) tablet for oral use. Available at:

Cush JJ. Approaches to articular and musculoskeletal disorders. In : Kasper DL, Fauci AS, Hauser SL, Longo Dl, Jameson JL, Localzo J editors. Harrisons principles of internal medicine. 19th ed. pp: 2218.

FDA Drug Safety Communication: FDA warns that DPP4 inhibitors for type 2 diabetes may cause severe joint pain. Available at: