Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Invokana (Canagliflozin).

Amputation: There may be an increased risk for lower leg or toe amputations in people taking Invokana (Canagliflozin), especially if you are at high risk for heart disease. Good foot care is very important for people with diabetes. Contact your doctor as soon as possible if you notice symptoms of leg pain; poor circulation; bluish, cold skin; and poor hair or toenail growth.

Cholesterol: Invokana (Canagliflozin) can cause increased blood cholesterol levels, particularly low-density lipoprotein. If you are at risk of developing High Cholesterol or you have high cholesterol levels before starting Invokana (Canagliflozin), discuss with your doctor how Invokana (Canagliflozin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Invokana (Canagliflozin), and whether any special monitoring is needed.

Diabetic ketoacidosis: If blood sugar levels are too high (hyperglycemia), a condition known as diabetic ketoacidosis may occur. In this condition, your body starts to use body fat as fuel, eventually leading to a large concentration of acid in the blood stream. This can result in unconsciousness, coma or death. Your risk of developing diabetic ketoacidosis may be increased if you are on a low carbohydrate diet, drink a lot of alcohol, have a severe illness or infection, or have problems with your pancreas. There have been reports of diabetic ketoacidosis in people taking Invokana (Canagliflozin).

If you develop symptoms of diabetic ketoacidosis such as difficulty breathing, feeling very thirsty, vomiting, abdominal pain, nausea, loss of appetite, confusion, and unusual tiredness, seek urgent medical attention.

Dizziness: Some people taking Invokana (Canagliflozin) may experience decreases in blood pressure. This occurs because the medication causes an increased amount of fluid, along with the glucose, to be removed from the body through the kidneys. These blood pressure drops could lead to dizziness, lightheadedness, and falls. This may occur when you shift your body position, such as rising from a sitting or lying position. If you experience this problem, try getting up more slowly. If it persists or if you faint, contact your doctor. Seniors and other individuals who are at risk of experiencing Low Blood Pressure (e.g., dehydration, taking medications for high blood pressure) should discuss with their doctor how Invokana (Canagliflozin) may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Invokana (Canagliflozin), and whether any special monitoring is needed.

Fractures: There is a small increase in the risk of bone fractures for people taking Invokana (Canagliflozin). If you are at risk of Osteoporosis or are taking medications that may decrease the strength of your bones, discuss with your doctor how Invokana (Canagliflozin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Invokana (Canagliflozin), and whether any special monitoring is needed.

Glucose control: When Invokana (Canagliflozin) is taken along with other medications for diabetes, glucose levels may drop too far, causing confusion, cold sweats, cool and pale skin, headache, fast heartbeat, or weakness. Your doctor may suggest decreasing the dose of your other medications when you first start taking Invokana (Canagliflozin). If you take other medications for diabetes, discuss with your doctor how Invokana (Canagliflozin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Invokana (Canagliflozin), and whether any special monitoring is needed.

Kidney function: Invokana (Canagliflozin) may cause a decrease in kidney function. If you have reduced kidney function or Kidney Disease, discuss with your doctor how Invokana (Canagliflozin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Invokana (Canagliflozin), and whether any special monitoring is needed.

Potassium levels: Increases in blood levels of potassium may occur when taking Invokana (Canagliflozin). This is more likely to happen to people who are taking other medications that prevent potassium from being removed from the body, or those who have moderately reduced kidney function. This doesn't often cause problems, but potassium levels should be monitored by your doctor. If you experience unexplained nausea, fatigue, muscle weakness or tingling sensations, contact your doctor.

Yeast infections: There is an increased risk of developing genital or vaginal yeast infections when taking Invokana (Canagliflozin) as a result of increased glucose in the urine. This is more likely to occur for uncircumcised males and for people who have a history of yeast infections.

Pregnancy: Invokana (Canagliflozin) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Invokana (Canagliflozin), contact your doctor immediately.

Breast-feeding: It is not known if Invokana (Canagliflozin) passes into breast milk. If you are a breast-feeding mother and are taking Invokana (Canagliflozin), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Invokana (Canagliflozin) have not been established for children less than 18 years of age.

Seniors: Seniors are more likely to experience side effects with Invokana (Canagliflozin) and may require lower doses.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Janumet.

Alcohol intake: Large amounts of alcohol or regular use of alcohol increases the risk of developing lactic acidosis when taking metformin. People taking Janumet should avoid excessive alcohol intake.

Blood glucose control: People taking Janumet who have a fever, experience trauma, or have surgery may experience a temporary loss of blood glucose control. At such times, it may be necessary to stop Janumet and temporarily inject insulin. Janumet may be started again after the problem is resolved.

Congestive Heart Failure (CHF): Congestive heart failure can increase the risk of lactic acidosis caused by metformin. For this reason, Janumet is not recommended for people with CHF. If you have CHF, speak to your doctor.

Diabetes complications: The use of Janumet will not prevent the development of complications of diabetes mellitus (e.g., kidney disease, nerve disease, eye disease).

Dye or contrast agents: If you are going to have an X-ray procedure that uses dye or a contrast agent, you may need to stop taking Janumet for a short time. Contact your doctor for instructions.

Hypersensitivity reaction: A severe allergic reaction called a hypersensitivity reaction has occurred for some people with the use of sitagliptin. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Kidney function: Kidney disease or reduced kidney function may cause metformin or sitagliptin to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Janumet may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Janumet, and whether any special monitoring is needed.

Sitagliptin may cause decreased kidney function, including kidney failure. Your doctor may recommend regular testing to check your kidney function while you are taking Janumet. Janumet is not recommended for people with reduced kidney function.

Lactic acidosis: Lactic acidosis is a rare but serious problem that occurs due to metformin accumulation (i.e., the body doesn't get rid of the medication fast enough) during treatment. People with severe kidney disease, heart failure, or dehydration are at higher risk of developing lactic acidosis. Since alcohol may increase the risk of lactic acidosis, do not drink a lot of alcohol over the short or long term while taking Janumet. When it does occur (very rarely), it is fatal in 50% of cases. If you experience symptoms of lactic acidosis (e.g., weakness; tiredness; drowsiness; unusual muscle pain; trouble breathing; stomach pain with nausea, vomiting, or diarrhea; feeling cold; dizziness; lightheadedness; slow or irregular heartbeat), stop taking Janumet and get immediate medical attention.

Liver function: Janumet is not recommended for people with severely reduced liver function. If you have moderately reduced liver function, discuss with your doctor how Janumet may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Janumet, and whether any special monitoring is needed.

Low blood glucose: Low blood glucose can occur when sitagliptin – metformin is used in combination with other medications to treat diabetes. Low blood glucose may also occur when not enough food is eaten, especially when strenuous exercise is undertaken at the same time or when large amounts of alcohol have been consumed. If you experience low blood sugar (e.g., headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, fast heartbeat, sweating, and feeling jittery) while taking Janumet, contact your doctor.

Pancreatitis: Janumet may cause pancreatitis (inflammation of the pancreas). If you have a history of pancreatitis, gallstones, Alcoholism, or high triglycerides you may be more at risk of experiencing this. If you experience prolonged and severe abdominal pain with or without vomiting while taking Janumet, contact your doctor immediately.

Reduced response: Over a period of time, people may become progressively less responsive to a particular treatment for diabetes because their diabetes worsens. If your blood glucose control worsens or you are not staying within your target levels, talk to your doctor.

Surgery: Janumet should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on Janumet once you are eating and drinking and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.

Thyroid function: People with low thyroid function may develop further decreases in the function of their thyroid. Symptoms of these changes include feeling cold all the time, weight gain, fatigue, dry skin, and decreased memory and concentration. Contact your doctor if you experience these symptoms.

Vitamin B12 levels: Janumet may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking Janumet.

Pregnancy: Janumet is not recommended for use during pregnancy or for women who are planning to become pregnant. If you become pregnant while taking Janumet, contact your doctor immediately. Insulin is usually used during pregnancy to control blood glucose levels.

Breast-feeding: It is not known if sitagliptin passes into breast milk. Metformin does pass into breast milk. If you are a breast-feeding mother and are taking Janumet, it may affect your baby. Janumet should not be used by women who are breast-feeding.

Children: The safety and effectiveness of Janumet have not been established for children less than 18 years of age.

Seniors: Kidney function often decreases with age. As a result, seniors may be more likely to experience side effects of Janumet.