What is Janumet?

Janumet is a film-coated tablet that contains Metformin and Sitagliptin. It is used to treat type 2 diabetes, in combination with a proper diet and exercise.

Janumet medicine 50mg/1000mg contains sitagliptin phosphate monohydrate and metformin hydrochloride. Metformin is a hypoglycemic agent by improving glucose tolerance in patients with type 2 diabetes, helping to reduce basal and postprandial blood glucose levels. Sitagliptin phosphate improves glycemic control in people with type 2 diabetes by increasing levels of the active hormone incretin.
Janumet is indicated for the treatment of type 2 diabetes, combined with a diet and physical activity in the following cases:
The patient has not been able to control blood sugar by adjusting the diet, motor; Patients who have not been able to control their blood sugar by taking metformin alone at the maximally tolerated dose or are taking a combination of metformin and sitagliptin; Triple therapy with sulfonylurea when the patient has not controlled blood sugar with any 2 of the 3 drugs: Metformin, sitagliptin or sulfonylurea. ; Triple therapy with a PPARγ agonist (thiazolidinediones class of drugs) when the patient has not been able to control blood sugar with any 2 of the 3 drugs Metformin, sitagliptin or a PPARγ agonist; Combination therapy with insulin. Janumet is contraindicated in the following cases:
Patients with severe renal failure with eGFR<30ml/min/1.73m2; People with a history of hypersensitivity to the components of the drug; Patients with acute or chronic metabolic acidosis, including diabetic ketoacidosis, comatose or not; People with acute or chronic diseases that can reduce tissue oxygen such as: respiratory failure, heart failure, myocardial infarction, shock; Patients with liver failure; Alcoholics, acute alcohol poisoning; Women who are breastfeeding.

Use Janumet on the basis of the current treatment regimen, effectiveness, and tolerability of the patient, not to exceed the maximum recommended daily dose of sitagliptin of 100 mg.
Janumet is usually taken twice a day with meals, gradually increasing the dose to reduce the gastrointestinal side effects that are common with metformin use.

3.1. Dosage of Janumet medicine for patients not taking metformin The starting dose is 50mg sitagliptin/500mg metformin x 2 times/day, taken orally; For patients with uncontrolled blood sugar and no gastrointestinal side effects, the dose of metformin can be increased every 1-2 weeks; Dosage adjustment of metformin should be considered on an individual basis based on efficacy and tolerability, not exceeding a maximum dose of 2,000 mg metformin/day. 3.2. Dosage for patients with inadequate glycemic control on metformin alone: ​​The starting dose is sitagliptin 50 mg twice daily (total dose 100 mg/day) with the same dose of metformin being used. 3.3. Dosage for patients with inadequate glycemic control on sitagliptin alone The initial dose is 50mg sitagliptin/500mg metformin hydrochloride twice daily; The dose may be increased to 50 mg sitagliptin/1,000 mg metformin twice daily. Janumet should not be switched to in patients receiving adjusted dose sitagliptin monotherapy for renal impairment. 3.4. Dosage for patients switching from a co-administration of sitagliptin to metformin Initiate Janumet at the same dose of sitagliptin and metformin the patient is taking. 3.5. Dosage for patients with inadequate glycemic control when 2 drugs are combined with any 2 of the 3 drugs: Sitagliptin, metformin or a sulfonylurea The starting dose is sitagliptin 50mg twice daily (total dose 100mg/day); The degree of glycemic control and the dose of metformin being used should be considered when determining the starting dose of metformin. 3.6. Dosage for patients with inadequate glycemic control when 2 drugs are combined with any 2 of the 3 drugs: sitagliptin, metformin or a PPARγ agonist (thiazolidinedione class): The starting dose is sitagliptin 50 mg twice daily (total). dose of 100mg/day); The degree of glycemic control and the dose of metformin being used should be considered when determining the starting dose of metformin. 3.7. Dosage for patients with poor glycemic control when 2 drugs are combined with any 2 of the 3 drugs: Sitagliptin, metformin or insulin The starting dose is sitagliptin 50mg x 2 times/day (total dose 100mg/day); The degree of glycemic control and the dose of metformin being used should be considered when determining the starting dose of metformin. 3.8. Dosage in patients with renal impairment Assess renal function after initiation of Janumet therapy and periodically thereafter; Contraindicated to use Janumet in patients with glomerular filtration rate (eGFR) <30 ml/min/1.73m2; Janumet should not be used in patients with eGFR ≥30ml/min/1.73m2 and <45ml/min/1.73m2 as these patients require a lower dose of sitagliptin than available doses of the Janumet dose combination product. 3.9. Dosage for patients with liver failure Do not use Janumet.
3.10. Dosage in the elderly Use caution because metformin and sitagliptin are mainly eliminated by the kidneys.
3.11. Dosage for children Janumet is not recommended for children under 18 years of age because there are not enough data to evaluate safety and effectiveness in this population.
The above dose of Janumet is for reference only. The specific dose will depend on the patient's condition and disease progression.

Overdose: When taking an overdose of sitagliptin phosphate, supportive measures should be applied (removal of the substance from the gastrointestinal tract, clinical monitoring and supportive therapy). With an overdose of metformin hydrochloride, patients may develop hypoglycemia or lactic acidosis. Metformin dialysis is required. Missed dose: When a dose of Janumet is missed, the patient should take it as soon as possible. If it is almost time for the next dose, the patient can skip the missed dose and take the next dose as scheduled.

When using Janumet, patients may experience some side effects:
Common: Skin (fungal infection, urticaria, erythema, photosensitivity), metabolism (hypoglycemia and decreased blood sugar). vitamin B12 levels), respiratory (cough), digestive (nausea, vomiting, abdominal pain, flatulence, indigestion); Uncommon: Skin (pruritus), gastrointestinal (constipation, diarrhea), hematopoietic disorders (aplastic anemia, blood dysplasia, hemolytic anemia, thrombocytopenia, myelosuppression, agranulocytosis), metabolism (lactic acidosis). When experiencing side effects, patients should stop using Janumet and immediately notify their doctor or go to the nearest hospital for timely treatment.

Before and while using Janumet, patients should pay attention:
Do not use Janumet for people with type 1 diabetes or for diabetic ketoacidosis; There is a risk of acute pancreatitis in patients taking sitagliptin (an ingredient in Janumet); There is an increased risk of metformin accumulation and lactic acidosis with the degree of renal impairment when Janumet is used. Therefore, do not use the drug in people with severe renal failure, with eGFR<30ml/min/1.73 m2; There have been cases of hypoglycaemia when Janumet is combined with a sulfonylurea (SU) or with insulin; There have been cases of serious hypersensitivity reactions when using sitagliptin (a component of the drug Janumet); There have been cases of pemphigoid blisters when using sitagliptin (DPP-4 inhibitor); There is a case of lactic acidosis due to metformin (a component of the drug Janumet); There is hypoglycaemia in patients taking metformin but with insufficient caloric tolerance, concomitant use of sulfonylureas and insulin or alcohol; Taking metformin can lower vitamin B12 levels in the body; If a patient with type 2 diabetes has previously been well controlled with Janumet but has abnormal laboratory results or has an equivocal clinical pathology that is difficult to determine, immediate testing should be done to determine the possibility of ketoacidosis or ketoacidosis. lactic acidosis; When a patient who is stable with a certain diabetes treatment regimen experiences fever, trauma, surgery, infection, etc., a temporary loss of blood sugar control may occur. At this point, the patient may need to stop taking Janumet, temporarily take insulin, and then restart Janumet after the acute episode is over; The use of Janumet in pregnancy and lactation is not recommended.

With sitagliptin and metformin:
Co-administration of multiple doses of sitagliptin 50 mg twice daily and metformin 1,000 mg twice daily did not alter the pharmacokinetics of sitagliptin or metformin in patients with type 2 diabetes.
With sitagliptin phosphate:
Sitagliptin has no clinical effect on the pharmacokinetics of the following drugs: Metformin, glyburide, simvastatin, rosiglitazone, warfarin and oral contraceptives; Drugs commonly used in patients with type 2 diabetes that do not have a clinical effect on the pharmacokinetics of sitagliptin include: anti-hypercholesterolemic drugs (statins, fibrates, ezetimibe), antiplatelet agents (clopidogrel), drugs antihypertensives (ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, β blockers, hydrochlorothiazide), nonsteroidal anti-inflammatory and analgesics (naproxen, diclofenac, celecoxib), antihypertensives depression (bupropion, fluoxetine, sertraline), antihistamines (cetirizine), proton pump inhibitors (omeprazole, lansoprazole), erectile dysfunction drugs (sildenafil). With metformin hydrochloride:
Nifedipine will increase the absorption of metformin; Drugs that reduce metformin clearance include: Concomitant use of drugs that interfere with the renal tubular transport involved in the renal elimination of metformin (organic cationic transporter - 2 [OCT2] ], MATE inhibitors such as ranolazine, vandetanib, dolutegravir and cimetidine) may increase systemic exposure to metformin, increasing the risk of lactic acidosis. Drugs with a tendency to cause hyperglycemia, possibly causing loss of glycemic control: Thiazides and other diuretics, phenothiazines, thyroid hormone products, corticosteroids, estrogens, nicotinic acid, drugs sympathomimetics, oral contraceptives, phenytoin, calcium channel blockers and isoniazid.When using Janumet, patients should follow all the instructions of their doctor to ensure effective treatment of type 2 diabetes, reduce the risk of diabetes. chances of encountering unpredictable side effects.