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Nesina, Kazano & Oseni

Nesina, Kazano and Oseni are Type 2 diabetes drugs manufactured by Takeda Pharmaceuticals. These drugs help stimulate the pancreas to release more insulin after meals to control blood sugar. But these combination drugs have been linked to side effects such as bladder cancer and pancreatitis.

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. All three drugs were approved in 2010 in Japan and then in January 2013 by the U.S. Food and Drug Administration (FDA).

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, a drug that belongs to a class of medications 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 JanuviaTradjentaOnglyza and Kombiglyze XR. Nesina would have been the first DPP-4 drug released in the U.S. But because the FDA had questions about the drug’s cardiovascular safety, Takeda was forced to conduct new safety trials before the drug could be approved.

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

The new alogliptin-based medicines have made millions for Takeda. In 2016, the company reported that Nesina made about $449 million in the U.S.

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 like pancreatitis and possible pancreatic cancer.

How Do Nesina, Kazano & Oseni Work?

Like other DPP-4 drugs, Nesina, Kazano and Oseni block DPP-4, an enzyme responsible for degrading the incretin hormone, glucagon-like peptide-1 (GLP-1). GLP-1 encourages the pancreas to secrete insulin after meals. It also regulates 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 allows the pancreas to secrete more insulin and the liver to produce less sugar. This helps control blood 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 absorbed into the blood from the intestines, reduces the amount of sugar produced by the liver and makes the body more sensitive to insulin.

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

Side Effects

All three drugs share similar side effects. The most common ones varied slightly in clinical trials but generally included colds and upper respiratory tract 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 carries no black box warning, the other two drugs do. Oseni includes a warning about congestive heart failure risk. Kazano carries a lactic acidosis warning. Serious side effects for all three drugs include kidney problems and allergic reactions.

Dosages & Strengths

Each dose of alogliptin and combination drug is different depending on the patient, especially if they have kidney problems. Because each patient may react differently to each medication, doctors may increase or decrease the dose after a patient begins treatment. In the case of Kazano and Oseni, these drugs use alogliptin in combination with varying strengths of metformin (Glucophage or Fortamet) and pioglitazone (Actos).

Nesina 6.25 mg Pills


6.25 mg, 12.5 mg or 25 mg tablets of alogliptin taken once daily with or without food. Patients with moderate kidney disease should go no higher than a 12.5 mg dose. For patients with severe kidney disease, the lowest dose of 6.25 mg is recommended.

Kazano 12.5mg Pills


12.5 mg alogliptin/500 mg metformin and 12.5 mg alogliptin/1000 mg metformin. Patients should take Kazano twice daily with food. Patients with severe kidney problems should not use Kazano.

Oseni Pills


25 mg alogliptin/15, 30 & 45 mg pioglitazone and 12.5 mg alogliptin/15, 30 & 45 mg pioglitazone. No dose of Oseni is safe for patients with severe renal impairment. Patients take Oseni once daily with food.

Drug Interactions

While researchers did not observe any drug interactions in clinical trials with alogliptin, Kazano and Oseni contain metformin and pioglitazone. These two medications have their own set of drug interactions. Kazano metformin interactions include: Alcohol, insulin, topiramate, zonisamide, estrogens, oral contraceptives, thyroid drugs. Oseni pioglitazone interactions include: Gemfibrozil and other CYP2C8 inhibitors.

Nesina, Kazano & Oseni pills
Nesina, Kazano & Oseni Facts
  1. Dosage 6.5 mg and up, varies depending on drug
  2. Used to Treat Type 2 diabetes
  3. Related Drugs Onglyza, Kombiglyze XR, Januvia
  4. FDA Black Box Warning Kazano for lactic acidosis, Oseni for heart failure
  5. Active Ingredient Alogliptin, metformin and pioglitazone or a combination depending on drug
  6. FDA Approval 2013

Please seek the advice of a medical professional before making health care decisions.

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Kristin Compton
Written By Kristin Compton Writer

Kristin Compton's background is in legal studies. She worked as a paralegal before joining Drugwatch as a writer and researcher. She was also a member of the National Association of Legal Assistants. A mother and longtime patient, she has firsthand experience of the harmful effects prescription drugs can have on women and their children. Some of her qualifications include:

  • Bachelor of Arts in Legal Studies | Pre-Law from University of West Florida
  • Past employment with The Health Law Firm and Kerrigan, Estess, Rankin, McLeod & Thompson LLC
  • Personal experience battling severe food allergies, asthma and high-risk pregnancies
Edited By
Medically Reviewed By
Dr. Joseph Palermo
Dr. Joseph Palermo Osteopathic Medicine

19 Cited Research Articles writers follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and interviews with qualified experts. Review our editorial policy to learn more about our process for producing accurate, current and balanced content.

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  3. National Institutes of Health. (2016). Oseni – alogliptin and pioglitazone tablet, film coated. Retrieved from
  4. Nainggolan, L. (2013, June 18). Latest DPP-4 inhibitor, alogliptin, reaches US market. Retrieved from
  5. Hirschler, B. (2013, September 2). Doctors get good and bad safety news on diabetes drugs. Reuters. Retrieved from
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  7. Perry, S. (2013, June 10). New generation of diabetes drugs raising more concerns. Minnesota Post. Retrieved from
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  10. Matsuyama, K. (2013, January 27). Takeda diabetes drug succeeding Actos wind FDA approval. Retrieved from
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  12. National Library of Medicine. (2013). Kazano (alogliptin and metformin hydrochloride). Daily Med. Retrieved from
  13. National Library of Medicine. (2013). Oseni (alogliptin and pioglitazone). Daily Med. Retrieved from
  14. Azoulay, L. et al. (2012). The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes. British Medical Journal, 344: e3645. Retrieved from
  15. White, W.B. et al. (2013). Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes. Retrieved from
  16. Mundell, E.J. (2013, September 2). New Diabetes Drug Seems Safe for Heart, Study Finds. Retrieved from
  17. Takeda. (2017). Annual Report 2016. Retrieved from
  18. U.S. National Library of Medicine. NIH. (2014, June 4). Type 2 diabetes: Overview. Retrieved from:
  19. Szalay, J. (2015, January 27). Pancreas: Function, Location & Diseases. Retrieved from:
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