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 Januvia (Sitagliptin).

Hypersensitivity reaction: A Anaphylaxis (severe allergic reaction) called hypersensitivity reaction has occurred for some people with the use of Januvia (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.

Immune system: Januvia (Sitagliptin) can reduce the number of cells that fight infection in the body (white blood cells). This side effect may be more of a concern for people who already have a weakened immune system. People who have HIV infection, have had an organ transplant and are taking medications to reduce the activity of the immune system, or are taking medication to treat certain types of cancer are more likely to have a weakened immune system. If any of these conditions apply to you, discuss with your doctor how Januvia (Sitagliptin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Januvia (Sitagliptin), and whether any special monitoring is needed.

Kidney function: Januvia (Sitagliptin) has been reported to cause decreased kidney function and may cause kidney failure. Your doctor may recommend regular testing to check your kidney function while you are taking Januvia (Sitagliptin). If you notice signs of kidney problems, such as decreased urine production; swelling in your hands, wrists, feet, or ankles; difficulty breathing, or weakness, contact your doctor as soon as possible.

People with decreased kidney function may require lower doses of Januvia (Sitagliptin). If you have Kidney Disease or decreased kidney function, discuss with your doctor how Januvia (Sitagliptin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Januvia (Sitagliptin), and whether any special monitoring is needed.

Januvia (Sitagliptin) is not recommended for people with moderately to severely reduced kidney function.

Liver function: Januvia (Sitagliptin) is not recommended for people with severely reduced liver function. People with moderately reduced liver function should discuss with their doctor how Januvia (Sitagliptin) may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Januvia (Sitagliptin), and whether any special monitoring is needed.

Low blood glucose (sugar): Hypoglycemia (low blood sugar) can occur when Januvia (Sitagliptin) is used in combination with metformin and a sulfonylurea (e.g., glyburide, gliclazide), or insulin. If you experience low blood sugar (e.g., headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, fast heartbeat, sweating, and feeling jittery) while taking Januvia (Sitagliptin), contact your doctor.

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

Type 1 Diabetes and diabetic ketoacidosis: Januvia (Sitagliptin) should not be used by people with type 1 diabetes or to treat diabetic ketoacidosis (increased ketones in the blood or urine).

Pregnancy: Januvia (Sitagliptin) is not recommended for use during pregnancy. If you become pregnant while taking Januvia (Sitagliptin), contact your doctor immediately.

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

Children: The safety and effectiveness of using Januvia (Sitagliptin) have not been established for children.

Seniors: Seniors are more likely to have decreased renal function and may require lower doses of Januvia (Sitagliptin).

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 Contrave.

Accidental ingestion: If you are dependent on narcotics and you ingest Contrave, you could experience severe symptoms of withdrawal including confusion, nausea, shakiness, sweating, anxiety, visual hallucinations, vomiting, or diarrhea. Avoid taking narcotic medications while you are taking naltrexone-bupropion.

Diabetes: Weight loss often causes decreased blood glucose. As a result, using naltrexone-bupropion may cause episodes of low blood sugar when taken by people with diabetes who are taking certain oral medications to control blood sugar. You may find it necessary to monitor your blood sugar more frequently while using Contrave.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Bupropion may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Contrave affects you.

Heart disease: Bupropion can increase blood pressure and heart rate. It is not known whether it is safe for use by people with a recent history of Heart Attack or unstable heart disease. If you have had a heart attack within the past 6 months, have an irregular heartbeat, high blood pressure, Congestive Heart Failure or a recent Stroke, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Galactose intolerance/glucose malabsorption: Contrave contains lactose. If you have lactose or galactose intolerance you should not take Contrave.

Glaucoma: Contrave may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking Contrave.

Identical medications: Wellbutrin®, Zyban® and several other medications contain bupropion. Revia® and Relistor® contain naltrexone. If you are taking naltrexone-bupropion, do not take any other product containing bupropion or naltrexone, as the risk of side effects increases with an increased dosage.

Interference with opiate-containing mediations: Because Contrave works by blocking the effects of opiates, it will reduce the effectiveness of narcotic pain relievers. It may also interfere with other medications that contain opiates such as certain cough and cold medications, antidiarrheal medications, and some analgesics (pain medications). Trying to overcome the blocking effects of naltrexone by taking larger doses of narcotics may result in severe side effects of the narcotic. Talk to your doctor or pharmacist about non-opiate containing alternatives.

Kidney function:  Kidney Disease or reduced kidney function may cause Contrave to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Contrave is not recommended for people with end-stage kidney disease.

Liver function: Liver disease or reduced liver function may cause Contrave to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Naltrexone-bupropion is not recommended for people with severely decreased liver function.

Naltrexone-bupropion has been reported to cause decreased liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Lupus: There may be an association between taking naltrexone – bupropion and the autoimmune conditions systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). If you develop any skin rash (particularly on the face), fatigue, joint pain, or swelling, contact your doctor as soon as possible.

Mental health: Bupropion may trigger mania and make behaviour and thought disturbances worse for people who have mental health conditions. It may also cause symptoms of psychosis and mania to develop for people who have not had these symptoms before. If you experience symptoms such as hallucinations, mania (feeling unusually over-excited or uninhibited), or delusional thinking, or notice them in a family member who is taking Contrave, contact your doctor as soon as possible. If you have mental health concerns, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Seizure risk: Bupropion may increase the risk of seizures. If you are at risk of seizures, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Things that increase the risk of seizures include:

• addiction to cocaine, stimulants, or opiates (such as morphine)
• diabetes treated with oral medications or insulin
• excessive alcohol use
• history of head trauma or seizures (including Epilepsy)
• severe liver problems
• tumours of the brain or spinal cord
• use of other medications that make seizures more likely (e.g., antipsychotics, antidepressants, lithium, theophylline, steroids)
• use of over-the-counter stimulants or appetite suppressants

Serotonin toxicity: Severe reactions are possible when naltrexone - bupropion is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.

Suicidal or agitated behaviour, or other behaviour changes: People taking Contrave may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking Contrave. If you experience these side effects or notice them in a family member who is taking Contrave, contact your doctor immediately. Your doctor will monitor you for emotional and behavioural changes while you are taking bupropion.

Pregnancy: Weight loss does not benefit a woman during pregnancy and may cause harm to the developing baby. Use of either of these medications may also cause harm to the developing baby. For these reasons, Contrave should not be used during pregnancy. If you become pregnant while taking Contrave, contact your doctor immediately.

Breast-feeding: Both naltrexone and bupropion pass into breast milk. If you are breast-feeding and are taking Contrave, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Contrave have not been established for children.

Seniors: Seniors may be at an increased risk of side effects due to age-related decreased kidney or liver function.