JANUMET ® 50 / 1000 MG ( SITAGLIPTIN / METFORMIN HYDROCHLORIDE ) 56 FILM-COATED TABLETS

Sitagliptin/ Metformin Hydrochloride is a prescription combination medication used to improve blood sugar control in adults with Type 2 diabetes mellitus. It combines two different anti-diabetic agents that work in complementary ways.

Common Brand Names:

• Janumet (Immediate-release)
• Janumet XR (Extended-release)
• Zituvimet and Zituvimet XR

How It Works?
The two active ingredients target different physiological processes to lower blood glucose: 

• Sitagliptin (DPP-4 Inhibitor): Increases the levels of natural substances called incretins. These hormones help the pancreas release more insulin when blood sugar is high and decrease the amount of sugar made by the liver.
• Metformin (Biguanide): Primarily reduces the amount of glucose produced by the liver and decreases the absorption of glucose in the intestines. It also helps the body respond better to its own insulin. 

Administration and Dosage

• Timing: Usually taken twice daily with meals (for immediate-release) to reduce stomach upset. Extended-release versions (XR) are typically taken once daily with the evening meal.
• Instructions: Tablets should be swallowed whole. Do not crush, cut, or chew them, especially the extended-release versions.
• Maximum Dose: Generally not to exceed 100 mg of sitagliptin and 2,000 mg of metformin per day. 

Common Side Effects
These typically occur when starting the medication and may improve over time: 

• Gastrointestinal: Diarrhea, nausea, vomiting, gas, and upset stomach.
• Respiratory: Stuffy or runny nose, sore throat, and upper respiratory tract infections.
• General: Headache and unusual weakness or tiredness. 

Serious Side Effects (Seek Medical Help Immediately)

• Lactic Acidosis: A rare but fatal buildup of lactic acid. Watch for unusual muscle pain, trouble breathing, feeling cold in arms/legs, dizziness, or a slow/irregular heartbeat.
• Pancreatitis: Inflammation of the pancreas marked by severe stomach pain that may spread to the back, often with nausea and vomiting.
• Severe Allergic Reactions: Symptoms include swelling of the face, lips, or throat, hives, rash, and difficulty breathing or swallowing.
• Heart Failure: Look for shortness of breath, sudden weight gain, or swelling in the feet and ankles.
• Severe Joint Pain: Some patients experience disabling joint pain that may require stopping the medication.
• Bullous Pemphigoid: A rare skin reaction causing large, hard blisters or skin breakdown.
• Kidney Problems: Signs include a change in the amount or frequency of urination.

Long-Term Considerations

• Vitamin B12 Deficiency: Long-term use can lower B12 levels, potentially causing anemia or nerve problems (tingling in hands/feet).
• Hypoglycemia: Low blood sugar is more likely if taken with other diabetes drugs like insulin or sulfonylureas. 

Note: To reduce stomach-related side effects, it is highly recommended to take this medication with meals. 
Electronic Medicines Compendium

Serious Risks and Warnings

• Lactic Acidosis: A rare but life-threatening buildup of lactic acid in the blood, often linked to metformin use in patients with kidney problems.
• Pancreatitis: Inflammation of the pancreas. Seek immediate medical help if you experience severe, persistent stomach pain that may reach through to your back.
• Kidney Function: Because metformin is cleared by the kidneys, this medication is usually not recommended for those with severe kidney disease.
• Hypoglycemia (Low Blood Sugar): While unlikely to cause low blood sugar on its own, the risk increases if used with other diabetes medications like insulin or sulfonylureas.

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