METFORMIN AND SITAGLIPTIN

(met FOR min and SI ta glip tin) Brand: Janumet, Janumet XR

What is the most significant information I must know about metformin and sitagliptin?

• You must not use this medicine if you are allergic to metformin (Glucophage) or sitagliptin (Januvia), if you have liver or kidney malady, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

• Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get abnormal medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cool feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart course, dizziness, or feeling very weak or weary.

• If you need to have any type of x-ray or CT scan using a paint that is injected into your veins, you will need to temporarily stop taking metformin and sitagliptin.

What is metformin and sitagliptin?

• Metformin and sitagliptin are oral diabetes medicines that help control blood sugar levels.

• Metformin works by decreasing glucose (sugar) manufacture in the liver and decreasing absorption of glucose by the intestines. Sitagliptin works by regulating the levels of insulin your body produces after eating.

• The combination of metformin and sitagliptin is used to treat type 2 diabetes. This medicine is not for treating type 1 diabetes.

• Metformin and sitagliptin may also be used for purposes not listed in this medicine guide.

What must I discuss with my health care provider till taking metformin and sitagliptin?

• Some people develop a life-threatening condition called lactic acidosis while taking metformin. You may be more likely to develop lactic acidosis if you have liver or kidney malady, congestive heart failure, a severe infection, if you are dehydrated, or if you drink big amounts of alcohol. Conversation with your doctor about your individual risk.

• You must not use this medicine if you are allergic to metformin (Actoplus Met, Avandamet, Fortamet, Glucophage, Riomet) or sitagliptin (Januvia), or if you have:

· kidney or liver malady; or

· if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

• To create certain you can safely take this medicine, speak your doctor if you have a history of heart malady or pancreatitis, or if you are over 80 years old and have not recently had your kidney function checked.

• If you need to have any type of x-ray or CT scan using a paint that is injected into your veins, you will need to temporarily stop taking metformin and sitagliptin. Be certain your caregivers know onward of time that you are using this medication.

• Determined oral diabetes medications may magnify your risk of serious heart problems. However, not treating your diabetes can hurt your heart and another organs.

• FDA pregnancy category B. This medicine is not expected to be deleterious to an unborn child. Speak your doctor if you are pregnant or plan to become pregnant during treatment.

• It is not known whether metformin and sitagliptin passes into breast milk or if it could harm a nursing child. Do not use this medicine without telling your doctor if you are breast-feeding a baby.

How must I take metformin and sitagliptin?

• Take exactly as predesigned by your doctor. Do not take in larger or less amounts or for longer than recommended. Follow the directions on your prescription label. Your blood sugar will need to be checked often, and you may need another blood trials at your doctor's office.

• Take metformin and sitagliptin with meals.

• Do not crush, chew, or interrupt an extended-release tablet. Swallow it intact. Breaking the pill may reason too many of the drug to be released at one time.

• Know the signs of low blood sugar (hypoglycemia) and how to recognize them: headache, famine, weakness, sweating, tremor, irritability, or trouble concentrating.

• Check your blood sugar carefully during a time of stress or diseases, if you travel, exercice more than normal, drink alcohol, or skip meals. These things can affect your glucose levels and your doze needs may also change.

• Always hold a source of sugar accessible in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and can't ate or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon abnormal injection kit and speak you how to give the injection.

• Ask your doctor how to adjust your metformin and sitagliptin doze if needed. Do not change your medicine doze or schedule without your doctor's advice.

• Metformin and sitagliptin is only part of a complete program of treatment that may also include diet, exercice, weight control, foot care, and eye care. Follow your diet, medicine, and exercice routines very closely.

• Store at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed doze as soon as you remember (be certain to take the medication with food). Skip the missed doze if it is nearly time for your following scheduled doze. Do not take extra medication to create up the missed dose.

What happens if I overdose?

• Search abnormal medical attention or call the Poison Help line at 1-800-222-1222. You may have signs of low blood sugar, such as extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

• An overdose of metformin may reason lactic acidosis. Get abnormal medical help if you have: weakness, increasing sleepiness, slow heart course, cool feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What must I avoid while taking metformin and sitagliptin?

• Avoid drinking alcohol. It lowers blood sugar and may magnify your risk of lactic acidosis.

What are the possible side effects of metformin and sitagliptin?

• This medicine may reason lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get abnormal medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness, numb or cool feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or irregular heart course, dizziness, or feeling very weak or tired.

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

• Call your doctor at once if you have any of these serious side effects:

· pancreatitis - severe pain in your upper stomach spreading to your back, nausea and vomiting, loss of appetite, quick heart rate;

· urinating smaller than normal or not at all;

· feeling short of breath (even with mild exertion) swelling or rapid weight gain; or

· severe skin reaction -- fever, sore throat, swelling in your person or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the person or upper body) and causes blistering and peeling.

• Smaller serious side effects may include:

· diarrhea, constipation, mild nausea, upset stomach;

· headache, weakness, back pain, joint or mucle pain; or

· cool symptoms such as runny or stuffy nose, sneezing, 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 message side effects to FDA at 1-800-FDA-1088.

What another drugs will affect metformin and sitagliptin?

• Speak your doctor about all another medicines you use, especially:

· acetazolamide (Diamox);

· cimetidine (Tagamet), ranitidine (Zantac);

· morphine (MS Contin, Kadian, Oramorph);

· ranitidine (Zantac);

· topiramate (Topamax);

· trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra) or vancomycin (Vancocin, Lyphocin);

· glipizide (Glucotrol, Metaglip), glimepiride (Amaryl, Avandaryl, Duetact), glyburide (DiaBeta, Micronase, Glucovance); or

· heart or blood pressure medications such as amiloride (Midamor), digoxin (Lanoxin), furosemide (Lasix), nifedipine (Nifedical, Procardia), procainamide (Procan, Pronestyl, Procanbid), quinidine (Quin-G), triamterene (Dyrenium).

• You may be more likely to have hyperglycemia (high blood sugar) if you take metformin and sitagliptin with another drugs that can raise blood sugar, such as:

· isoniazid;

· diuretics (water pills);

· steroids (prednisone and others);

· heart or blood pressure medicine (Cartia, Cardizem, Covera, Isoptin, Verelan, and others);

· niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others);

· phenothiazines (Compazine and others);

· thyroid medication (Synthroid and others);

· birth control pills and another hormones;

· seizure medicines (Dilantin and others); or

· diet pills or medicines to treat asthma, colds or allergies.

• These lists are not complete and there are much another medicines that can magnify or decrease the effects of metformin and sitagliptin on lowering your blood sugar. Speak your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal commodity. Do not start a new medicine without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about metformin and sitagliptin.

Remember, hold this and all another medicines out of the reach of children, never share your medicines with others, and use this medicine only for the indication prescribed.

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