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Precautions and Warnings With Sitagliptin and Metformin

Specific Precautions and Warnings With Sitagliptin and Metformin

Precautions and warnings to be aware of prior to taking sitagliptin and metformin include the following:
  • Very preliminary data suggests incretin mimetics, such as sitagliptin and metformin, may increase the risk of precancerous cellular changes (called pancreatic duct metaplasia) in people with type 2 diabetes. Researchers are continuing to study the possibility that incretin mimetics might increase the risk of pancreatic cancer, although at this time there is not enough information to know for sure if there is any increased risk.
  • There have been some reports of pancreatitis in people taking sitagliptin (one of the components of this medication). This is probably most likely to occur shortly after the drug is first started or when the dosage is increased. Be sure to let your healthcare provider know right away if you have signs of pancreatitis, such as:
    • Nausea
    • Vomiting
    • Loss of appetite
    • Severe, persistent abdominal pain that sometimes radiates to the back.
  • In rare cases, the metformin component of sitagliptin and metformin may cause a life-threatening condition called lactic acidosis. Your risk for this increases with other medical conditions, including congestive heart failure, kidney failure, and liver problems, including liver failure and cirrhosis (see Metformin and Lactic Acidosis).
  • Drinking alcohol can increase your risk of lactic acidosis. Drinking large amounts of alcohol on a regular basis or drinking a large amount of alcohol at once (binge drinking) should be avoided while taking sitagliptin and metformin (see Metformin and Alcohol).
  • Since liver disease (including liver failure and cirrhosis) can increase your risk of lactic acidosis, you should not take sitagliptin and metformin if your liver is not functioning normally.
  • Your kidney function needs to be monitored while you are taking sitagliptin and metformin. This means that you should have blood tests to check your kidneys before you start the medication and then again at least once every year. If your kidney function is very poor, you should not take the drug, due to increased risk of lactic acidosis.
  • Taking sitagliptin and metformin and contrast dye at the same time can increase your risk of kidney damage. Contrast dye is used for certain radiology procedures, including some x-rays, CT scans, and heart catheterizations (see Metformin and Contrast Medium). Also, the medication should be temporarily stopped for most major surgeries and restarted when you are eating normally again.
  • Fever, infections, injury, or surgery can temporarily increase your blood sugar, even in people with well-controlled diabetes. Sitagliptin and metformin may not be enough to treat your diabetes at these times, and the use of insulin may be required. Contact your healthcare provider if you have a fever, infection, injury, or will be having surgery. Also, make sure that you know the symptoms of high blood sugar and how to check your blood sugar levels (see Janumet and Blood Sugar).
  • Let your healthcare provider know if you have an illness that causes severe vomiting, diarrhea, or fever, or if you drink a much lower amount of liquid than normal. These conditions can lead to severe dehydration (loss of water in your body). You may need to stop taking sitagliptin and metformin temporarily during these times.
  • Sitagliptin and metformin can decrease your levels of vitamin B12. Your healthcare provider should monitor your vitamin B12 levels, especially if you have a vitamin B12 deficiency (including pernicious anemia).
  • Sitagliptin and metformin can interact with certain medications (see Drug Interactions With Sitagliptin and Metformin).
  • Sitagliptin and metformin is considered a pregnancy Category B medication. This means that it is probably safe for use in pregnant women, although the full risks are not known. Talk to your healthcare provider before taking the medication while pregnant (see Janumet and Pregnancy).
  • It is not known if sitagliptin and metformin passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Janumet and Breastfeeding).
  • In rare cases, sitagliptin and metformin can cause low blood sugar (hypoglycemia), usually when it is combined with other diabetes medications. This has been more common in elderly people and in people with adrenal, pituitary, liver, or kidney problems -- as well as during fasting before surgery and after prolonged exercise. Symptoms of low blood sugar include irritability, trembling, cold sweats, or blurry vision, among other things (see Janumet and Blood Sugar).
Diabetes Tips for Seniors

Sitagliptin and Metformin (Janumet)

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