Janumet (Sitagliptin Metformin)
How to treat type 2 diabetes? Treatment course implies not only pills, but also a change in the entire way of life. Diabetes mellitus type 2 is a condition when insulin is not accepted by its receptors almost in all tissues and organs, so it remains unused.
To put it simple insulin fits the receptor, which is on the surface of every cell of our entire body, as the key fits the lock. For certain reasons, this receptor-lock is broken, and the insulin key cannot open it, but it is really necessary to let glucose enter the cells, as it is the main fuel of our body.
However, since insulin does not do its job, meaning it does not deliver glucose to the cells, the glucose also accumulates in the blood, and this is an additional stimulus for the pancreas to start producing even more insulin.
Typically, insulin resistance is most common in people who are overweight, but studies have shown that in 25% of cases it can also occur in people with normal body weight. It is proved by the fact that not only obesity affects insulin sensitivity.
In addition to obesity, there are following causes for the insulin resistance development:
- taking certain medications (glucocorticoids, thiazide diuretics, beta-blockers for the cure of hypertension and heartbeat)
- low physical activity
- genetic defects of the receptor
Obesity plays a leading role in the development of insulin resistance. After gaining 35-40% of the standard weight the insulin sensitivity decreases by 40%. This fact is proved by numerous studies.
To treat this disease, many methods are used, including diet, sport exercises, getting rid of smoking as well as a therapy course. Diabetes mellitus type 2 is treated with both blood glucose lowering drugs and insulin. There are many antidiabetic drugs against of type 2 diabetes today. One of them is Janumet XR.
Due to effect of Metformin and Sitagliptin, which are two key elements of the remedy, the hypoglycemic action of this pharmaceutical product is substantially enhanced. They complement each other, reducing the blood sugar level.
Sitagliptin is a DPP-4 inhibitor, activating incretins, which, in turn regulate glucose homeostasis. When needed they help to improve the insulin secretion. This suppresses the release of glucagon and, as a consequence, the synthesis of glucose in the liver.
Metformin is biguanide, which increases tolerance to glucose, and then reduces its concentration in the blood and synthesis in the liver. Additionally, the sensitivity of cells to glucose is enhanced.
Under certain conditions it is needed to be extremely careful when treating with Janumet (Metformin).
- Acute pancreatitis. Sitagliptin can strengthen its manifestations. The physician has to warn the individual: in the presence of pain in the abdominal region or right upper quadrant, it is necessary to terminate the drug usage.
- Lactat acid acidosis. It is a heavy and rather frequent condition leading to dangerously fatal consequences. In case of manifestations expression, therapy regimen must be interrupted. It is recognized as respiratory embarrassment, epigastric pain, chills, dysemia, muscle spasms, asthenia, gastrointestinal tract disorders.
- Glycopenia. Usually it would not develop when diabetes is cured using the mentioned medication. But it can be provoked by excessive physical activity, a calorie-controlled diet (up to 1000 kcal per day), renal and pituitary glands problems, alcohol addiction, and beta-blockers usage. It enhances the likelihood of glucopenia in parallel with insulin-based therapy.
- Renal pathologies. The lactat acid acidosis development risk is increased in presence of renal disorder that is why it is so vital to monitor the creatinine ratio. Especially it concerns diabetics of mature age, because renal disorders in them can proceed asymptomatically.
- Increased sensation. In case allergic symptoms manifestation, the medication must be withdrawn.
- Surgery. If a diabetic intends for a planned operation, the Janumet treatment course must be canceled two days before and the patient must be put for insulin-based therapy.
- Iodine-containing products. When iodine-based remedy is taken together with Janumet, it can provoke a renal system problem.
Moreover, there are additional contraindications preventing use of Janumet (Metformin):
- Kussmaul's coma;
- Infectious diseases;
- Shock states;
- Diseases provoking hypoxia in tissues;
- Liver dysfunction, poisoning, alcohol abuse;
- Pregnancy including breastfeeding;
- Type I diabetes.
- Age under18 years
Also it ought to be mentioned that since the main excretion pathway of Sitagliptin and Metformin lies through the renal system, and due to the fact that excretion function of the kidneys reduces with age, the doctor prescribing Janumet (Metformin) must take this aspect into account. The dosage for elderly patients must be carefully adjusted and they have to be under close supervision of treating physician.
What is Metformin?
Generic Janumet (Sitagliptin Metformin) does not affect the ability to manage vehicles or complex mechanisms, but Synagliptin can result in weakness and drowsiness, that’s why this drug is not recommended in case when prompt reaction and high attention is essential.
The Janumet dose schedule must be selected based on individual characteristics, as well as on the applied treatment course, effectiveness and tolerance, but it should not exceed the highest daily dose amounting to 100 mg of Sitagliptin.
Metformin dosage recommendations:
The initial dosage of Janumet (Metformin) is based on the undergoing hypoglycemic treatment course. The medicine has to be taken two times a day along with food.
Gradual increase in dosage is necessary in order to minimize GIT disorders.
HOW TO TAKE METFORMIN?
Usually, tablets are consumed twice a day, at the start and at the end of the day. Gradual increase of dose is allowed. The treatment course should be started with either 50 mg of Sitagliptin or 500 mg of Metformin twice a day, plus the dosage of currently taken substances. When switching from combined treatment with these substances, the dose remains the same and, if necessary, it can be corrected.
Digestive tract disorder: at the start of the treatment, there can be such manifestations as abepithymia, diarrhea, sickness, retching, flatus, celialgia (diminishing during food intake); metallic aftertaste in the mouth (3%).
Heart-vascular and blood system (hematopoiesis, blood stasis): in separate events megaloblastic anemia can develop (as a result of vitamin B12 and folic acid malabsorption).
Metabolism: glucopenia; in some cases lacticacidemia can develop (resistant bradyarrhythmia, fragility, hypersomnia, arterial hypotension, respiratory disorders, stomach pain, myodynia, hypothermy).
On top of the above mentioned the following adverse reactions can be experienced:
- Skin: eruption, scytitis.
- Nausea, abdominal pain;
- Metallic taste in the mouth;
- Diarrhea or constipation;
- Dry mouth;
- Allergic reactions;
- Lactic acidosis;
- Peripheral edema.
The lactoacidosis may develop in case of overdose. In this case, it is required to remove the drug remnants from the body, then hemodialysis shall be carried out and the patient's condition shall be monitored.
Symptoms of hypoglycemia are also possible. In case of a light form, it is recommended to take a meal rich in carbohydrates. In the case of moderate and severe forms, the injection of glucagon or dextrose solution will be required, as well as bringing the patient into consciousness and further taking food containing carbohydrates. Then, it is necessary to contact the attending physician for medicine dose correction.
Concomitant diseases require correction of the selected treatment strategy. If they are available, it is necessary to combat several pathologies at once, accordingly, there is a need for combining different medications. Detailed investigations of Janumet influence on other medicines have not been performed. But it is known that it can change the effectiveness of some drugs when used together with them. Among them are: Furosemide; Nifedipine; Digoxin; Cyclosporin; Januvia. If there is a need for such combinations, the selection of the dosage should be taken with care and course of treatment must be monitored. This drug is considered to be effective in the diabetes therapy course, but it is not always suitable for all patients. Because of this, it is sometimes better to select medicines with an equal effect.
Cimetidine can inhibit the effect of metformin hcl 500 mg, which may result in the acidosis development.
Basically, the interaction of the Sitagliptin with other products did not show clinically defined signs, so there are no contraindications to concomitant admission.
Concomitant treatment with sulfonylurea or insulin can lead to hypoglycemia development, especially when the dosage is exceeded.
Metformin and Alcohol
This product is not compatible with alcohol, since ethanol affects its efficiency.
The doctors' opinion of this pharmaceutical product is unanimous. They say: an important advantage of its components (especially Sitagliptin) is that they do not provoke low blood sugar. If prescribed regimen is not critically violated and recommendations on nutrition and sport exercise are carried out, the glucose level will be stably low. If there is discomfort in the epigastrium and other undesirable effects, the daily dose must be divided into two doses for the purpose of the body load decrease. After adaptation, you can return to the previous regimen. In case if sugar level is above of the target values the dosage adjustment by the attending physician is recommended.
Below please find some the feedbacks:
Anton: I was prescribed Janumet (Metformin) by my doctor. During 2 years I take 2 tablets a day. My doctor and I are satisfied with its action: the sugar level is stable, and my overall health condition has been improved. The medication is rather expensive, but, in my opinion, it is the one of the best.
Tatyana: I tried this medicine for the first time. In combination with physical work and tablets, I also lost 12 kg in 1.5 months. I'm very happy with the drugs, although it's expensive.
Leonid: Yes, it is irreplaceable now (there are no complete analogs) drug for diabetes mellitus with very high proven efficacy.