metformin and sitagliptin
Generic Name: metformin and sitagliptin (met FOR min and SI ta glip tin)
Brand Name: Janumet, Janumet XR
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 used to treat type 2 diabetes. This medication is not for treating type 1 diabetes.
Metformin and sitagliptin may also be used for purposes not listed in this medication guide.
What is the most important information I should know about metformin and sitagliptin?
You should not use this medication if you are allergic to metformin (Glucophage) or sitagliptin (Januvia), if you have liver or kidney disease, 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 emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.
If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and sitagliptin.
What should I discuss with my health care provider before 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 disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your individual risk.
You should not use this medication if you are allergic to metformin (Actoplus Met, Avandamet, Fortamet, Glucophage, Riomet) or sitagliptin (Januvia), or if you have:
kidney or liver disease; or
if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).
To make sure you can safely take this medication, tell your doctor if you have a history of heart disease 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 dye that is injected into your veins, you will need to temporarily stop taking metformin and sitagliptin. Be sure your caregivers know ahead of time that you are using this medication.
Certain oral diabetes medications may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell 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 baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
How should I take metformin and sitagliptin?
Take exactly as prescribed by your doctor. Do not take in larger or smaller 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 other blood tests at your doctor's office.
Take metformin and sitagliptin with meals.
Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.
Know the signs of low blood sugar (hypoglycemia) and how to recognize them: headache, hunger, weakness, sweating, tremor, irritability, or trouble concentrating.
Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change.
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.
Ask your doctor how to adjust your metformin and sitagliptin dose if needed. Do not change your medication dose or schedule without your doctor's advice.
Metformin and sitagliptin is only part of a complete program of treatment that may also include diet, exercise, weight control, foot care, and eye care. Follow your diet, medication, and exercise routines very closely.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency 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 cause lactic acidosis. Get emergency medical help if you have: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.
What should I avoid while taking metformin and sitagliptin?
Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis.
Metformin and sitagliptin side effects
This medication may cause 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 emergency medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or irregular heart rate, dizziness, or feeling very weak or tired.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, 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, fast heart rate;
urinating less than usual 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 face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Less serious side effects may include:
diarrhea, constipation, mild nausea, upset stomach;
headache, weakness, back pain, joint or mucle pain; or
cold 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 report side effects to FDA at 1-800-FDA-1088.
See also: metformin and sitagliptin side effects (in more detail)
Metformin and sitagliptin Dosing Information
Usual Adult Dose for Diabetes Type 2:
The starting dose of metformin-sitagliptin should be individualized based on the patient's current regimen, while not exceeding the maximum recommended dose of 2000 mg metformin and 100 mg of sitagliptin.
Metformin-sitagliptin immediate release:
For patients not adequately controlled on metformin alone, the usual starting dose of metformin-sitagliptin should be equal to 100 mg total daily dose (50 mg twice daily) of sitagliptin plus the dose of metformin already being taken. For patients taking metformin 850 mg twice daily, the recommended starting dose of metformin-sitagliptin is 50 mg sitagliptin/1000 mg metformin hydrochloride twice daily.
For patients not adequately controlled on sitagliptin alone, the usual starting dose of metformin-sitagliptin is 50 mg sitagliptin/500 mg metformin hydrochloride twice daily. Patients may be titrated up to 50 mg sitagliptin/1000 mg metformin hydrochloride twice daily. Patients taking sitagliptin monotherapy with the dose adjusted for renal insufficiency should not be switched to metformin-sitagliptin.
For patients switching from sitagliptin administrated with metformin, metformin-sitagliptin may be initiated at the dose of sitagliptin and metformin already being taken.
Metformin-sitagliptin should be given twice daily with meals, with gradual dose escalation, to reduce the gastrointestinal (GI) side effects due to metformin.
Metformin-sitagliptin extended release:
In patients not currently treated with metformin, the recommended total daily starting dose is 1000 mg metformin/100 mg sitagliptin. Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose.
In patients already treated with metformin, the recommended total daily starting dose is 100 mg sitagliptin and the previously prescribed dose of metformin.
For patients taking metformin immediate-release 850 mg twice daily or 1000 mg twice daily, the recommended starting dose is two 1000 mg metformin/50 mg sitagliptin extended-release tablets taken together once daily.
Maintain the same total daily dose of metformin and sitagliptin when changing between immediate-release and extended release.
Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose.
What other drugs will affect metformin and sitagliptin?
Tell your doctor about all other medicines you use, especially:
cimetidine (Tagamet), ranitidine (Zantac);
morphine (MS Contin, Kadian, Oramorph);
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 other drugs that can raise blood sugar, such as:
diuretics (water pills);
steroids (prednisone and others);
heart or blood pressure medication (Cartia, Cardizem, Covera, Isoptin, Verelan, and others);
niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others);
phenothiazines (Compazine and others);
thyroid medicine (Synthroid and others);
birth control pills and other 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 many other medicines that can increase or decrease the effects of metformin and sitagliptin on lowering your blood sugar. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More about metformin/sitagliptin
- Sitagliptin/metformin extended-release tablets
- Metformin and sitagliptin (Advanced Reading)
- Sitagliptin and metformin (Advanced Reading)
Compare with other treatments for:
Where can I get more information?
- Your pharmacist can provide more information about metformin and sitagliptin.
- 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.
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