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Janumet

Generic Name: metformin and sitagliptin (met FOR min and SI ta glip tin)
Brand Names: Janumet

What is metformin and sitagliptin?

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

Metformin works by decreasing glucose (sugar) production 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 for people with type 2 diabetes who do not use daily insulin injections. This medication is not for treating type 1 diabetes.

Metformin and sitagliptin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about metformin and sitagliptin?

Before taking metformin and sitagliptin, tell your doctor if you have liver disease or a history of heart disease.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin and sitagliptin.

What should I discuss with my health care provider before taking metformin and sitagliptin?

You may be more likely to develop lactic acidosis if you have congestive heart failure. Older adults may also have a higher risk of developing lactic acidosis. Talk with your doctor about your individual risk.

Before taking metformin and sitagliptin, tell your doctor if you are allergic to any drugs, or if you have:

• liver disease; or

• a history of heart disease.

If you have any of these conditions, you may not be able to use metformin and sitagliptin, or you may need a dosage adjustment or special tests during treatment.

Your name may need to be listed on a Janumet pregnancy registry if you become pregnant while you are taking this medication. The purpose of this registry is to track the outcome of the pregnancy and delivery to evaluate whether metformin and sitagliptin had any effect on the baby.

How should I take metformin and sitagliptin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Metformin and sitagliptin is usually taken twice daily with meals. Follow your doctor"s instructions.

Metformin and sitagliptin is only part of a complete program of treatment that also includes diet, exercise, weight control, and possibly other medications. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking metformin and sitagliptin for a short time if any of these situations affect you.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

• hunger, headache, confusion, irritability;

• drowsiness, weakness, dizziness, tremors;

• sweating, fast heartbeat;

• seizure (convulsions); or

• fainting, coma (severe hypoglycemia can be fatal).

Always keep a source of sugar available 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 cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

Your doctor may have you take extra vitamin B12 while you are taking metformin and sitagliptin. Take only the amount of vitamin B12 that your doctor has prescribed.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin and sitagliptin. Be sure the doctor knows ahead of time that you are using this medication.

Store metformin and sitagliptin at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food if your doctor has instructed you to). If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

What should I avoid while taking metformin and sitagliptin?

Metformin and sitagliptin side effects

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

• feeling short of breath, even with mild exertion;

• swelling or rapid weight gain; or

• fever, chills, body aches, flu symptoms.

Other less serious side effects may be more likely to occur, such as:

• runny or stuffy nose, sore throat;

• headache, weakness; or

• mild nausesa, vomiting, diarrhea, gas, stomach pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect metformin and sitagliptin?

You may be more likely to have hyperglycemia (high blood sugar) if you are taking metformin and sitagliptin with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;

• diuretics (water pills);

• steroids (prednisone and others);

• phenothiazines (Compazine and others);

• thyroid medicine (Synthroid and others);

• birth control pills and other hormones;

• seizure medicines (Dilantin and others); and

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

You may be more likely to have hypoglycemia (low blood sugar) if you are taking metformin and sitagliptin with other drugs that lower blood sugar. Drugs that can lower blood sugar include:

• some nonsteroidal anti-inflammatory drugs (NSAIDs);

• aspirin or other salicylates (including Pepto-Bismol);

• sulfa drugs (Bactrim and others);

• a monoamine oxidase inhibitor (MAOI);

• beta-blockers (Tenormin and others); or

• probenecid (Benemid).

Some medications may interact with metformin and sitagliptin. Tell your doctor if you are using any of the following drugs:

• amiloride (Midamor) or triamterene (Dyrenium);

• cimetidine (Tagamet) or ranitidine (Zantac);

• digoxin (Lanoxin);

• furosemide (Lasix);

• morphine (MS Contin, Kadian, Oramorph);

• nifedipine (Adalat, Procardia);

• procainamide (Procan, Pronestyl, Procanbid);

• quinidine (Cardioquin, Quinidex, Quinaglute);

• trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra); or

• vancomycin (Vancocin, Lyphocin).

If you are using any of these drugs, you may not be able to take metformin and sitagliptin, or you may require a dosage adjustment or special monitoring.

There may be other drugs not listed that can affect metformin and sitagliptin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has information about metformin and sitagliptin written for health professionals that you may read.

What does my medication look like?

Metformin and sitagliptin is available with a prescription under the brand name Janumet. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Janumet 50 mg/500 mg--light pink, capsule-shaped film-coated tablet

• Janumet 50 mg/1000 mg--red, capsule-shaped film-coated tablet

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ("Multum") is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum"s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum"s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.