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 this medication.
Alcohol intake: Large amounts of alcohol or regular use of alcohol increases the risk of developing lactic acidosis when taking metformin. People taking this medication should avoid excessive alcohol intake.
Blood glucose control: People taking this medication 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 this medication and temporarily inject insulin. This medication 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, this medication is not recommended for people with CHF. If you have CHF, speak to your doctor.
Diabetes complications: The use of this medication 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 this medication for a short time. Contact your doctor for instructions.
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 this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, 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 this medication. This medication 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 this medication. 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 this medication and get immediate medical attention.
Liver function: This medication is not recommended for people with severely reduced liver function. If you have moderately reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Low blood glucose: Under usual circumstances, low blood glucose does not occur for people who take this medication. Low blood glucose could 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 this medication, contact your doctor.
Pancreatitis: This medication 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 this medication, 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: This medication should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on this medication once you are eating and drinking and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.
Vitamin B12 levels: This medication may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking this medication.
Pregnancy: This medication is not recommended for use during pregnancy or for women who are planning to become pregnant. If you become pregnant while taking this medication, contact your doctor immediately. Insulin is usually used during pregnancy to control blood glucose levels.
Breast-feeding: It is not known if sitagliptin - metformin passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication should not be used by women who are breast-feeding.
Children: The safety and effectiveness of this medication 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 this medication.