Buy Janumet (Metformin, Sitagliptin) online


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How and where to order Janumet (Metformin Hydrochloride and Sitagliptin Phosphate Monohydrate) 50/500 mg and 50/1000 mg tablets online:

Shop:	PHARM X SELLER - 10% discount coupon 918cc60b466a42ba
Sellers:	METFORMIN/SITAGLIPTIN STORES
Prices:	from $0.61 per vial
Forms:	50/500 mg, 50/1000 mg tablets
Quantity:	15-182 pills
Type:	Istamet brand, Janumet brand and generics
Payment:	Visa, Mastercard, AmEx, Cryptocurrency
Delivery:	Standard airmail and trackable courier service
Shipping:	Worldwide, including USA, UK, Europe, Canada, Australia

Indications and usage:

Janumet is a combination of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, and metformin hydrochloride, a biguanide, indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Limitations of use:

this medication should not be used in patien ts with type 1 diabetes.

Janumet has not been studied in patients with a history of pancreatitis.

Dosage and administration:

Take this medicine orally twice daily with meals.

Individualize the dosage of Janumet on the basis of the patient's current regimen, effectiveness, and tolerability.

The maximum recommended daily dose is 100 mg of sitagliptin and 2000 mg of metformin HCl.

The recommended starting dose in patie nts not currently treated with metformin is 50 mg sitagliptin and 500 mg metformin HCl twice daily, with gradual dose escalation recommended to reduce gastrointestinal side effects associated with metformin.

The starting dose in patients already treated with metformin should provide sitagliptin dosed as 50 mg twice daily (100 mg total daily dose) and the dose of metformin already being taken. For patients taking metformin HCl 850 mg twice daily, the recommended starting dose of Janumet is 50 mg sitagliptin and 1000 mg metformin HCl twice daily.

Prior to initiation, assess renal function with estimated glomerular filtration rate (eGFR)

- Do not use in patients with eGFR below 30 mL/min/1.73 m2.
- This drug is not recommended in patients with eGFR between 30 and less than 45 mL/min/1.73 m2.

Janumet may need to be discontinued at time of, or prior to, iodinated contrast imaging procedures.

Dosage forms and strengt:

Janumet tablets containing sitagliptin 50 mg and metformin HCl 500 mg.

Janumet tablets containing sitagliptin 50 mg and metformin HCl 1000 mg.

Overdosage:

In the event of overdose with Janumet, contact the Poison Control Center in your living region.

In the event of an overdose, it is reasonable to employ supportive measures, e.g., remove unabsorbed material from the gastrointestinal tract, employ clinical monitoring (including obtaining an electrocardiogram), and institute supportive therapy as indicated by the patient's clinical status.

Sitagliptin is modestly dialyzable. In clinical studies, approximately 13.5% of the dose was removed over a 3- to 4-hour hemodialysis session. Prolonged hemodialysis may be considered if clinically appropriate. It is not known if sitagliptin is dialyzable by peritoneal dialysis.

Overdose of metformin has occurred, including ingestion of amounts greater than 50 grams. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases. Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected.

Contraindications:

Severe renal impairment: (eGFR below 30 mL/min/1.73 m2).

Metabolic acidosis, including diabetic ketoacidosis.

History of a serious hypersensitivity reaction to Janumet, sitagliptin, or metformin, such as anaphylaxis or angioedema.

Warnings and precautions:

Lactic acidosis: see boxed warning.

Pancreatitis: there have been postmarketing reports of acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. If pancreatitis is suspected, promptly discontinue Janumet.

Heart failure: has been observed with two other members of the DPP-4 inhibitor class. Consider risks and benefits of this medication in patients who have known risk factors for heart failure. Monitor patients for signs and symptoms.

Acute renal failure: has been reported postmarketing, sometimes requiring dialysis. Before initiating Janumet and at least annually thereafter, assess renal function.

Vitamin B12 deficiency: metformin may lower vitamin B12 levels. Measure hematologic parameters annually and vitamin B12 at 2 to 3 year intervals and manage any abnormalities.

Hypoglycemia with concomitant use with insulin or insulin secretagogues: increased risk of hypoglycemia when used in combination with insulin and/or an insulin secretagogue. A l ower dose of insulin or insulin secretagogue may be required.

Hypersensitivity reactions: there have been postmarketing reports of serious allergic and hypersensitivity reactions in patients treated with sitagliptin such as anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. Promptly stop Janumet, assess for other potential causes, institute appropriate monitoring and treatment.

Severe and disabling arthralgia: has been reported in patients taking DPP-4 inhibitors. Consider as a possible cause for severe joint pain and discontinue drug if appropriate.

Bullous pemphigoid: there have been postmarketing reports requiring hospitalization in patients taking DPP-4 inhibitors. Tell patients to report development of blisters or erosions. If bullous pemphigoid is suspected, discontinue this medication.

Adverse reactions, side effects:

The most common adverse reactions of Janumet and Istamet reported in >= 5% of patients simultaneously started on sitagliptin and metformin and more commonly than in patients treated with placebo were diarrhea, upper respiratory tract infection, and head ache.

To report suspected side effects of Janumet (Metformin Hydrochloride and Sitagliptin Phosphate Monohydrate) 50/500 mg and 50/1000 mg tablets contact Merck pharmaceutical company or your local FDA.

Drug interactions:

Carbonic anhydrase inhibitors may increase risk of lactic acidosis. Consider more frequent monitoring.

Drugs that reduce metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine) may increase the accumulation of metformin. Consider the benefits and risks of concomitant use.

Alcohol can potentiate the effect of metformin on lactate metabolism. Warn patients against excessive alcohol intake.

Related medications:

Glimepiride (Amaryl)

Metformin HCl tablets

Use in specific populations:

Pregnancy

The limited available data with Janumet in pregnant women are not sufficient to inform a drug-associated risk for major birth defects and miscarriage.

Pregnancy

There is no information regarding the presence of this drug in human milk, the effects on the breastfed infant, or the effects on milk production.

Females and males of reproductive potential

Advise premenopausal females of the potential for an unintended pregnancy.

Geriatric use

Assess renal function more frequently.

Hepatic impairment

Avoid use Janumet (Sitagliptin and Metformin HCl) tablets in patients with hepatic impairment.

PAtient counseling information:

Lactic acidosis

Explain the risks of lactic acidosis, its symptoms, and conditions that predispose to its development. Advise patients to discontinue Janumet immediately and to promptly notify their healthcare provider if unexplained hyperventilation, myalgias, malaise, unusual somnolence or other nonspecific symptoms occur. Counsel patients against excessive alcohol intake and inform patients about the importance of regular testing of renal function while receiving this medication. Instruct patients to inform their doctor that they are taking Janumet prior to any surgical or radiological procedure, as temporary discontinuation may be required.

Pancreatitis

Inform patients that acute pancreatitis has been reported during postmarketing use of this medicine. Inform patients that persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Instruct p atients to promptly discontinue Janumet (Metformin, Sitagliptin) pills and contact their physician if persistent severe abdominal pain occurs.

Heart failure

Inform patients of the signs and symptoms of heart failure. Before initiating this drug, ask patients about a history of heart failure or other risk factors for heart failure including moderate to severe renal impairment. Instruct patients to contact their health care provider as soon as possible if they experience symptoms of heart failure, including increasing shortness of breath, rapid increase in wei ght or swelling of the feet.

Vitamin B12 deficiency

Inform patients about the importance of regular monitoring of hematological parameters while receiving Janumet.

Hypoglycemia

Inform patients that the incidence of hypoglycemia is increased when this medication is added to an insulin secretagogue (e.g., sulfonylurea) or insulin therapy. Explain to patients receiving Janumet (Metformin HCl with Sitagliptin) tablets in combination with these medications the risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development.

Hypersensitivity reactions

Inform patients that allergic reactions have been reported during postmarketing use of sitagliptin, one of the components of this medicine. If symptoms of allergic reactions (including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing) occur, patients must stop taking Janumet and seek medical advice promptly.

Severe and disabling arthralgia

Inform patients that severe and disabling joint pain may occur with this class of drugs. The time to onset of symptoms can range from one day to years. Instruct patients to seek medical advice if severe joint pain occurs.

Bullous pemphigoid

Inform patients that bullous pemphigoid may occur with this class of drugs. Instruct patients to seek medical advice if blisters or erosions occur.

Females of reproductive age

Inform females that treatment with Janumet may result in ovulation in some premenopausal anovulatory women which may lead to unintended pregnancy.

Administration instructions

Inform patients that the tablets must never be split or divided before swallowing.

Where to buy metformin and sitagliptin online:

To purchase Janumet (Metformin Hydrochloride, Sitagliptin Phosphate Monohydrate) tablets from reliable online pharmacies and drugstores at low prices please use resources described above on this webpage.

Here is a list of popular medications containing metformin with sitagliptin as main active pharmaceutical ingredients; their trade names, forms, doses, companies - manufacturers, distributors, suppliers, researchers and developers:

Trade name of the drug	Pharmaceutical forms and doses	Companies
Istamet	Tablets, Film-Coated; Oral; Metformin Hydrochloride 500 mg; Sitagliptin Phosphate 50 mg Tablets, Film-Coated; Oral; Metformin Hydrochloride 1000 mg; Sitagliptin Phosphate 50 mg	Merck Sun Pharmaceutical Industries
Janumet	Tablets, Film-Coated; Oral; Metformin Hydrochloride 500 mg; Sitagliptin Phosphate 50 mg Tablets, Film-Coated; Oral; Metformin Hydrochloride 850 mg; Sitagliptin Phosphate 50 mg Tablets, Film-Coated; Oral; Metformin Hydrochloride 1000 mg; Sitagliptin Phosphate 50 mg	Merck Agencia Lei Va Hong DKSH Four Star Frosst Iberica OBS Healthcare Vistor Zuellig Pharma
Janumet-XR	Tablets, Extended Release; Oral; Metformin Hydrochloride 500 mg; Sitagliptin Phosphate 50 mg Tablets, Extended Release; Oral; Metformin Hydrochloride 1000 mg; Sitagliptin Phosphate 50 mg Tablets, Extended Release; Oral; Metformin Hydrochloride 1000 mg; Sitagliptin Phosphate 100 mg	Merck Zuellig Pharma
Velmetia	Tablets, Film-Coated; Oral; Metformin Hydrochloride 500 mg; Sitagliptin Phosphate 50 mg Tablets, Film-Coated; Oral; Metformin Hydrochloride 850 mg; Sitagliptin Phosphate 50 mg Tablets, Film-Coated; Oral; Metformin Hydrochloride 1000 mg; Sitagliptin Phosphate 50 mg	Merck Berlin-Chemie Egis Ferrer Internacional Medinfar Laboratorio Menarini Natrapharm Neopharmed Gentili Orion Pharma Pierre Fabre Polpharma Vistor