Nesina, Kazano & Oseni

Nesina (alogliptin), Kazano (alogliptin and metformin hydrochloride) and Oseni (alogliptin and pioglitazone) are oral drugs developed by Japan-based Takeda Pharmaceuticals, Inc. Its partner, Furiex Pharmaceuticals, markets the drugs. Regulators in Japan approved all three drugs in 2010, and the U.S. Food and Drug Administration (FDA) approved them in January 2013.

Along with diet and exercise, Nesina, Kazano and Oseni help control blood sugar in people with Type 2 diabetes. The drugs are not intended for use in patients with Type 1 diabetes or ketoacidosis.

The main active ingredient in all three medications is alogliptin, which belongs to a class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. Drugs in this class help stimulate the release of more insulin after a meal to control blood sugar. Other drugs in the class include Januvia, Tradjenta, Onglyza and Kombiglyze XR.

Nesina is Takeda’s follow-up medication to its blockbuster diabetes drug, Actos (pioglitazone). At the height of its sales in 2011, Actos topped out at $4.5 billion worldwide and made up 27% of the company’s revenue. The patent on Actos expired in August 2012, but Takeda combined pioglitazone and alogliptin to create Oseni.

Studies have shown that drugs in the DPP-4 class are effective at controlling blood sugar, but other studies have linked them to serious side effects such as pancreatitis and possible pancreatic cancer.

Like other DPP-4 drugs, Nesina, Kazano and Oseni block the DPP-4 enzyme, which is responsible for breaking down a hormone called glucagon-like peptide-1 (GLP-1). GLP-1 regulates blood sugar levels by stimulating the pancreas to secrete insulin after meals and controlling how much sugar the liver produces.

By blocking DPP-4 from breaking down GLP-1 in people with Type 2 diabetes, alogliptin allows GLP-1 to remain in the blood longer. This helps control blood sugar by allowing the pancreas to secrete more insulin and the liver to produce less sugar.

Kazano combines alogliptin with metformin. In addition to controlling blood sugar by blocking DPP-4, the metformin in Kazano reduces the amount of sugar produced by the liver and absorbed through the intestines, making the body more sensitive to insulin.

Oseni combines alogliptin with pioglitazone, the active ingredient in Actos. Like Nesina and Kazano, Oseni also blocks DPP-4, and pioglitazone works by increasing the body’s sensitivity to insulin.

The most common side effects of all three medications are colds and upper respiratory infections.

Nesina users also reported headaches, while Oseni users reported back pain. Kazano users reported both side effects, plus diarrhea and high blood pressure.

While Nesina does not have an FDA black box warning, the agency’s most serious form of medication alert, the other two drugs do. Oseni includes a black box warning about congestive heart failure risk, while Kazano carries one for lactic acidosis. Kazano carries a lactic acidosis. Serious side effects for all three drugs include kidney problems and allergic reactions.

Researchers gathered data from 14,778 patients with Type 2 diabetes to conduct clinical trials, according to the Nesina medication insert. The average age of trial participants was 58 years, and they used the medication for an average of 49 weeks. 3,348 patients used the drug for more than a year. The trials allowed researchers to compile data about the most common side effects associated with the drug. In these trials, common side effects were those that occurred in 4% or more of trial participants.

The most common Nesina side effects include:

• Common cold (4.8%)
• Upper respiratory tract infection (4.5%)
• Headache (4.3%)

The majority of side effects found in clinical trials were not serious. But after the medication hit the market, the FDA and Takeda began receiving reports of adverse events.

As of November 2025, the FDA had received 789 reports of Nesina side effects, according to the FDA Adverse Events Reporting System (FAERS) Public Dashboard. Of these reports, 646 cases were serious and included 64 deaths. Pemphigold, an autoimmune disease that affects the skin and mucous membranes, accounted for the most reported cases, followed by interstitial lung disease and acute pancreatitis. People also reported gastrointestinal issues such as nausea.

Takeda’s Nesina label warns that several side effects may be fatal or require hospitalization.

Black Box Warnings

Because Oseni is a combination of alogliptin and pioglitazone, it can cause all of the side effects of Nesina and pioglitazone. Because it contains pioglitazone, Oseni carries a black box warning for congestive heart failure.

Kazano also has a black box warning for the risk of lactic acidosis because it includes metformin.

Researchers did not observe any drug interactions in clinical trials with alogliptin. However, Kazano and Oseni contain metformin and pioglitazone, respectively. These two medications have their own sets of drug interactions. Kazano’s metformin interactions include alcohol, insulin, topiramate, zonisamide, estrogens, oral contraceptives and thyroid drugs. Oseni’s pioglitazone interactions include gemfibrozil, rifampin and topiramate.