Janumet

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What Is Janumet?

Janumet is a fixed-dose combination oral antidiabetic tablet containing sitagliptin (50 mg) and metformin hydrochloride (500 mg or 1000 mg), manufactured by Merck & Co. Available in packs of 56, 112 or 168 tablets. It is used when monotherapy with either component is not enough, or as initial combination therapy when HbA1c is substantially above target.

How Does Janumet Work?

Janumet combines two complementary mechanisms that do not overlap:

• Metformin — activates AMP-activated protein kinase (AMPK) in the liver, reducing hepatic glucose production. Also improves peripheral insulin sensitivity in muscle and fat. Does not stimulate insulin release — so no hypoglycaemia on its own.
• sitagliptin — a DPP-4 inhibitor (“gliptin”). Blocks the enzyme that breaks down GLP-1 and GIP, raising active incretin levels. This stimulates glucose-dependent insulin release and suppresses glucagon — only when blood glucose is elevated.

Because neither component stimulates insulin release independent of blood glucose, the combination has a very low hypoglycaemia risk. Typical HbA1c reduction: 1.5–2.0 percentage points. Weight effect: neutral or slightly weight-reducing (from metformin).

Dosage and Administration

Usual dose: one tablet twice daily, with breakfast and dinner. Dose is individualised based on prior therapy, HbA1c target, and renal function.

• Take with food — improves metformin tolerability.
• Miss a dose? Skip it — take the next at the normal time.
• Renal dosing: Dose is chosen based on renal function — sitagliptin 50 mg + metformin is suitable for eGFR 30–60; avoid if eGFR < 30.
• Hold for IV contrast, surgery, or acute illness with dehydration.
• Check vitamin B12 annually on long-term metformin.

Side Effects

From metformin (usually first 1–2 weeks):

• Diarrhoea, nausea, abdominal cramps, flatulence, metallic taste, loss of appetite

From the DPP-4 inhibitor:

• Upper respiratory infection, nasopharyngitis, headache
• Rare pancreatitis, severe arthralgia, bullous pemphigoid

Uncommon but serious:

• Lactic acidosis from metformin — very rare; almost always with AKI, sepsis, or hypoxia
• Vitamin B12 deficiency (long-term metformin)
• Acute pancreatitis — stop if severe abdominal pain

Drug Interactions

• Sulfonylureas, insulin, meglitinides — additive glucose-lowering; doses of these may need reduction to avoid hypoglycaemia.
• IV iodinated contrast — hold Janumet pre- and post-procedure if eGFR < 60.
• Cationic drugs (cimetidine, dolutegravir, ranolazine) — raise metformin levels.
• Carbonic anhydrase inhibitors (acetazolamide, topiramate) — additive acidosis risk.
• Strong CYP3A4 inhibitors — may raise saxagliptin levels (not relevant for sitagliptin/linagliptin/vildagliptin).
• Corticosteroids, thiazides, beta-2 agonists — may raise blood glucose.

Who Should Not Take Janumet?

• Type 1 diabetes mellitus or diabetic ketoacidosis
• Severe renal impairment (eGFR < 30)
• Severe hepatic impairment
• Acute illness with tissue-hypoxia risk
• History of hypersensitivity to either component
• History of pancreatitis (relative)
• Pregnancy and breastfeeding
• Before and 48 hours after IV iodinated contrast if eGFR < 60

Storage

Store Janumet below 30°C in a dry place, in the original blister pack. Keep out of reach of children.

Frequently Asked Questions

Is Janumet the same as taking Januvia and metformin separately?

Clinically, yes — same molecules at the same doses. The fixed-dose combination improves adherence, reduces pill burden, and typically costs less than the two components bought separately. The trade-off is less dose flexibility.

Will Janumet cause hypoglycaemia?

On its own, very rarely. Neither DPP-4 inhibitors nor metformin stimulates insulin release independent of glucose. Hypoglycaemia becomes a concern only when Janumet is combined with a sulfonylurea, meglitinide, or insulin.

Will I gain weight on Janumet?

No. The combination is weight-neutral or slightly weight-reducing, which is a major reason it is preferred over sulfonylurea-based combinations in overweight patients.

How long before Janumet starts working?

Fasting glucose starts to fall within a week. Maximal HbA1c effect is at 12 weeks. If HbA1c has not fallen by at least 0.5% after 3 months at the target dose, additional therapy may be needed.

Can I drink alcohol while taking Janumet?

Moderate alcohol with food is usually safe. Avoid binge drinking — it raises lactic acidosis risk (metformin) and can impair liver function.

Where can I buy Janumet online?

You can order Janumet (Sitagliptin 50 mg + Metformin 500/1000 mg) from MedsBase in packs of 56, 112 or 168 tablets. We ship worldwide, with discreet packaging and genuine WHO-GMP certified manufacturer stock.

Related Diabetes Medications

• Januvia — Sitagliptin monotherapy
• Trajenta — Linagliptin monotherapy
• Glycomet SR — Metformin sustained-release
• Jardiance — Empagliflozin (SGLT-2 alternative)
• Forxiga — Dapagliflozin (SGLT-2 alternative)
• Browse all Diabetes Medications

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