Sitagliptin/Metformin
Janumet XR
Janumet XR is a medication used to improve blood sugar levels in adults with Type 2 Diabetes Mellitus. It combines two drugs, sitagliptin, and metformin, to help control blood sugar levels effectively. Sitagliptin works by increasing insulin release, while metformin decreases sugar production in the liver and improves insulin sensitivity. Janumet XR is taken once daily with food and comes in various strengths. It is essential to monitor renal function before and during treatment, as Janumet XR is not suitable for patients with severe kidney problems. Common side effects include low blood sugar, gastrointestinal issues, and cold symptoms. Patients should follow their doctor’s instructions closely and maintain a regular diet and exercise routine.
Product Overview
Janumet XR is a combination medication made to manage blood sugar levels in adults with type 2 diabetes mellitus (T2DM). It contains two main ingredients: sitagliptin, which increases insulin release and decreases sugar production by the liver, and extended-release metformin, which improves insulin sensitivity and reduces glucose absorption from the intestines. This medication is used as an adjunct to diet and exercise to enhance glycemic control in individuals with T2DM.
Janumet XR comes in strengths of 50 mg sitagliptin/500 mg metformin, 50 mg sitagliptin/1000 mg metformin, and 100 mg sitagliptin/1000 mg metformin. It is taken orally once daily with a meal to reduce gastrointestinal side effects. The medication is suitable for patients who are not currently treated with metformin as well as those who are already taking metformin. However, it is not recommended for patients with severe kidney disease, liver impairment, or metabolic acidosis, including diabetic ketoacidosis.
Common side effects of Janumet XR include low blood sugar, stomach upset, headache, and cold symptoms. More severe side effects can consist of lactic acidosis, allergic reactions, and kidney issues. It’s important to follow the prescribed dosage, monitor renal function, and consult a healthcare provider if any adverse effects occur. Patients should store Janumet XR at room temperature and away from moisture. In case of a missed dose, it should be taken as soon as remembered unless it’s close to the time for the next dose. In the event of an overdose, immediate medical attention is required.
Uses of Janumet XR
- Improve blood sugar levels in people with Type 2 Diabetes.
How to Use Janumet XR?
Dosage
Janumet XR comes as an extended-release (ER) oral tablets and has 3 strengths:
- 50 mg sitagliptin / 500 mg metformin
- 50 mg sitagliptin / 1000 mg metformin
- 100 mg sitagliptin / 1000 mg metformin
Recommended Dosage for Different Patients
For Patients Not Currently on Metformin:
- Start with 100 mg sitagliptin and 1000 mg metformin HCl extended-release once daily.
- Increase the dose gradually to minimize metformin-related gastrointestinal side effects.
For Patients Already on Metformin:
- Begin with 100 mg sitagliptin and the current metformin dose.
- If taking 850 mg or 1000 mg of metformin HCl immediate-release twice daily, start JANUMET XR with two 50 mg sitagliptin and 1000 mg metformin HCl extended-release tablets once daily.
- Maximum Dose: Do not exceed a daily dose of 100 mg sitagliptin and 2000 mg metformin HCl extended-release.
Renal Function Considerations:
- Check kidney function before starting Janumet XR and regularly after that.
- Janumet XR is not to be used if the estimated glomerular filtration rate (eGFR) is below 30 mL/min/1.73 m².
- Do not start Janumet XR if the eGFR is between 30 and 45 mL/min/1.73 m².
- Stop Janumet XR before iodinated contrast imaging procedures if the eGFR is between 30 and 60 mL/min/1.73 m².
Dosage Adjustments for Kidney Impairment:
- Discontinue Janumet XR if the eGFR falls below 30 mL/min/1.73 m² during treatment.
- For patients with an eGFR between 30 and 45 mL/min/1.73 m², reduce the sitagliptin component to 50 mg once daily.
[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]
How to Take It?
- Follow Your Doctor’s Instructions: Take Janumet XR exactly as prescribed by your healthcare provider.
- With Food: Take Janumet XR with a meal to reduce the risk of an upset stomach.
- Swallow Whole: Do not crush, chew, or break the extended-release tablets. They must be swallowed whole to ensure the medication is released slowly into your body.
- Regular Schedule: Try to take Janumet XR at the same time each day to maintain an even level of the medication in your bloodstream.
- Monitoring: Keep regular appointments with your doctor to monitor your blood sugar levels and adjust your dose if necessary.
- Diet and Exercise: Continue following any diet and exercise plan recommended by your doctor.
- Do Not Stop Abruptly: Do not stop taking Janumet XR without consulting your healthcare provider, as this could worsen your condition.
[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]
How Does Janumet XR Work?
Janumet XR combines two medications, sitagliptin, and extended-release metformin, to treat type 2 diabetes. Sitagliptin increases insulin release and decreases sugar production by the liver, while metformin improves insulin sensitivity and reduces glucose absorption from the intestines. Together, they help lower blood sugar levels more effectively than either medication alone, especially when used alongside diet and exercise.
Important Safety Information
Side Effects
Common side effects may include:
- Low blood sugar (especially if you’re also taking insulin or another oral diabetes medication);
- Stomach upset, indigestion, gas, diarrhea, nausea, vomiting;
- Headache, weakness, or
- Cold symptoms like a runny or stuffy nose, sneezing, and sore throat.
Adverse/Serious side effects may include:
- Painful blisters on areas like the palms, abdomen, groin, and soles of the feet
- Itching
- Redness or discoloration around the affected area
- Hypoglycemia
- Headache
- Dizziness
- Confusion
- Sweating
- Pancreatitis
- Loss of appetite
- Diarrhea, nausea, or vomiting
- Jaundice
- Swelling, tenderness, and stiffness around the affected joint
- Lactic Acidosis (dangerous buildup of lactic acid in your body)
- Allergic Reaction
- Heart Problems
- Kidney Issues
[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]
Warnings
- Do not use Janumet XR if you have severe kidney disease or diabetic ketoacidosis (seek treatment from your doctor).
- Be aware of the risk of lactic acidosis, a dangerous accumulation of lactic acid in your blood.
- If you experience unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired, contact your doctor or seek emergency medical help immediately.
Precautions
- Follow Your Doctor’s Instructions: Take the medication exactly as prescribed by your healthcare provider.
- Dosage: Typically, Janumet XR is taken once daily with food to reduce the risk of stomach upset.
- Swallow Whole: Do not crush, chew, or break the extended-release tablets. They must be swallowed whole to ensure the medication is released slowly into your body.
- Regular Schedule: Try to take the medication at the same time each day to maintain an even level of the drug in your bloodstream.
- Monitoring: Keep regular appointments with your doctor to monitor your blood sugar levels and adjust your dose if necessary.
- Diet and Exercise: Continue following any diet and exercise plan recommended by your doctor.
- Do Not Stop Abruptly: Do not stop taking Janumet XR without consulting your healthcare provider, as this could worsen your condition.
Janumet XR Contraindications
In patients with known hypersensitivity to sitagliptin, metformin, or any of the components of Janumet XR. Hypersensitivity reactions can include anaphylaxis, angioedema, and exfoliative skin conditions.
- In patients with renal disease or dysfunction.
- In patients with metabolic acidosis or diabetic ketoacidosis
- In patients with hepatic impairment
Missed Dose
- If you miss a dose of Janumet XR, take it as soon as you remember.
- If it’s close to the time for your next dose, skip the missed dose and resume your regular dosing schedule.
- If you need help deciding whether to take a missed dose or skip it, consult your doctor or pharmacist.
- Avoid taking extra doses of Janumet XR to compensate for a missed dose, as this can increase your risk of side effects.
[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]
Overdose
An overdose of Janumet XR can lead to serious symptoms, including lactic acidosis, which is a dangerous accumulation of lactic acid in the body, and hypoglycemia, or low blood sugar levels. If you suspect an overdose, it is crucial to seek immediate medical attention.
[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]
Storage
- Keep the medication at room temperature, between 68°F to 77°F (20°C to 25°C).
- Store Janumet XR in its original container to protect it from moisture.
- Keep the medication in a dry place, away from direct light and moisture.
- Make sure the medication is out of reach of children and pets.
- Do not use Janumet XR after the expiration date printed on the bottle.
- Dispose of any unused or expired medication properly. Consult your pharmacist or local waste disposal company for guidance on safe disposal methods.
[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]
Janumet XR Interactions
- Iodinated Contrast Media: These agents, used in certain radiology procedures, can increase the risk of lactic acidosis in patients taking metformin.
- Diuretics: Especially loop diuretics can increase the risk of hypoglycemia and affect kidney function.
- Cationic Drugs: Such as amiloride, digoxin, procainamide, morphine, quinidine, quinine, trimethoprim, ranitidine, triamterene, and vancomycin that are eliminated by renal tubular secretion hold the potential for interaction with metformin by competing for common renal tubular transport systems.
- Insulin or Other Oral Diabetes Medications: The use of these medications with Janumet XR may increase the risk of hypoglycemia (low blood sugar).
- Alcohol: Heavy alcohol use can increase the risk of lactic acidosis, especially in people with liver problems or heart failure.
- Beta-Blockers: These medications can mask the symptoms of hypoglycemia.
- Corticosteroids, Thyroid Medications, and Sympathomimetics: These can reduce the blood sugar-lowering effect of Janumet XR.
- Angiotensin-converting enzyme (ACE) Inhibitors: These can lower blood sugar levels.
[Note: This isn’t a complete list, and there could be other drugs that interact with Janumet XR. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]
Janumet XR Alternatives
- Jardiance (empagliflozin)
- Invokana (canagliflozin)
- Farxiga (dapagliflozin)
- Glucophage XR (metformin extended-release)
- Tradjenta (linagliptin)
- Onglyza (saxagliptin)
- Victoza (liraglutide)
- Trulicity (dulaglutide)
- Ozempic (semaglutide)
- Bydureon (exenatide extended-release)
[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]
Frequently Asked Questions
Can Janumet (sitagliptin/metformin) affect kidney function?
There have been instances where Janumet (sitagliptin/metformin) has led to worsening kidney function, including acute kidney issues that sometimes needed dialysis. Due to this risk, your healthcare provider will conduct blood tests to monitor your kidney function before and during treatment to ensure the medication is safe for you. Janumet (sitagliptin/metformin) may not be suitable for individuals with kidney problems.
Why is it recommended that Janumet XR be taken in the evening?
The reason for the manufacturer’s recommendation to take Janumet XR (sitagliptin/metformin) in the evening is not entirely clear. However, research indicates that DPP-4 inhibitors like sitagliptin, which is one of the components of Janumet XR, may be effective in managing morning hyperglycemia (high blood sugar levels in the morning).
Does Janumet (sitagliptin/metformin) lead to weight loss?
While Janumet (sitagliptin/metformin) is not officially approved for weight loss, some people in clinical trials experienced weight loss while taking it. This effect is likely due to metformin, one of the components of Janumet, which is known to have a positive impact on weight. However, the number of participants who lost weight with Janumet was similar to those who took metformin alone or a placebo. Therefore, any weight loss effect might be attributed to the recommended balanced diet and exercise plan that accompanies this medication.
What should you avoid when taking Janumet?
If a patient is prescribed Januvia or Janumet alongside medications that can lead to hypoglycemia or deficient blood sugar levels, like sulfonylureas or insulin. Patients using it must take caution to avoid excessive lowering of blood sugar. It is crucial to be mindful of potential drug interactions, such as with Digoxin in the case of Januvia. Additionally, the consumption of alcohol can significantly heighten the risk of lactic acidosis when taking Janumet.
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