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 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.