JANUMET 50 mg/1000 mg FILM-COATED TABLETS

2. What you need to know before you take Janumet

Do not take Janumet

• if you are allergic to sitagliptin, metformin, or any of the other ingredients of this medicine (listed in section 6)
• if you have severe kidney problems
• if you have uncontrolled diabetes with, for example, severe hyperglycemia (high blood sugar), nausea, vomiting, diarrhea, rapid weight loss, lactic acidosis (see “Risk of lactic acidosis” below), or ketoacidosis. Ketoacidosis is a condition in which substances called “ketone bodies” build up in the blood, which can lead to diabetic pre-coma. The symptoms include stomach pain, rapid and deep breathing, drowsiness, or your breath developing an unusual fruity odor
• if you have a severe infection or are dehydrated
• if you are going to have an X-ray where you will be injected with a contrast agent. You will need to stop taking Janumet at the time of the X-ray and for 2 or more days after, as instructed by your doctor, depending on your kidney function
• if you have recently had a heart attack or have severe circulatory problems, such as “shock” or breathing difficulties
• if you have liver problems
• if you drink a lot of alcohol (either every day or only occasionally)
• if you are breast-feeding.

Do not take Janumet if any of the above applies to you and consult your doctor about other ways to control your diabetes. If you are not sure, consult your doctor, pharmacist, or nurse before taking Janumet.

Warnings and precautions

There have been reports of pancreatitis in patients taking Janumet (see section 4).

If you notice blisters on your skin, it may be a sign of a disease called bullous pemphigoid. Your doctor may ask you to stop taking Janumet.

Risk of lactic acidosis

Janumet may cause a very rare but very serious side effect called lactic acidosis, especially if your kidneys are not working properly. The risk of developing lactic acidosis is also increased with uncontrolled diabetes, serious infections, prolonged fasting, or alcohol intake, dehydration (see more information below), liver problems, and any medical condition in which a part of your body has a reduced supply of oxygen (such as acute and severe heart disease).

If any of the above applies to you, consult your doctor for more instructions.

Consult your doctor promptly to advise you what to do if:

• You know you have a genetic disease affecting the mitochondria (the energy-producing components within cells), such as MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or maternally inherited diabetes and deafness (MIDD).
• You experience any of the following symptoms after starting treatment with metformin: convulsions, cognitive impairment, difficulty with body movements, symptoms indicating nerve damage (e.g., pain or numbness), migraine, and hearing loss.

Stop taking Janumet for a short time if you have a condition that may be associated with dehydration(significant loss of body fluids), such as severe vomiting, diarrhea, fever, heat exposure, or if you drink less fluid than normal. Consult your doctor for more instructions.

Stop taking Janumet and contact a doctor or the nearest hospital immediately if you experience any of the symptoms of lactic acidosis, as this condition can lead to coma.

The symptoms of lactic acidosis include:

• vomiting
• stomach pain (abdominal pain)
• muscle cramps
• general feeling of being unwell, with intense tiredness
• difficulty breathing
• reduced body temperature and heart rate

Lactic acidosis is a medical emergency and must be treated in a hospital.

Consult your doctor or pharmacist before starting Janumet:

• if you have or have had pancreatitis (inflammation of the pancreas)
• if you have or have had gallstones, alcohol dependence, or very high blood levels of triglycerides (a type of fat). These medical conditions may increase your chance of developing pancreatitis (see section 4)
• if you have type 1 diabetes. This condition is also called insulin-dependent diabetes
• if you have had an allergic reaction to sitagliptin, metformin, or Janumet (see section 4)
• if you are taking a sulfonylurea or insulin, other diabetes medicines, because you may experience low blood sugar levels (hypoglycemia). Your doctor may need to reduce the dose of the sulfonylurea or insulin you are taking

If you need to have major surgery, you should stop taking Janumet during the procedure and for some time after. Your doctor will decide when you should stop taking Janumet and when you can start taking it again.

If you are not sure if any of the above applies to you, consult your doctor or pharmacist before taking Janumet.

During treatment with Janumet, your doctor will check your kidney function at least once a year or more often if you are an older person and/or if your kidney function is getting worse.

Children and adolescents

Children and adolescents under 18 years should not use this medicine. It is not effective in children and adolescents aged 10 to 17 years. It is not known if this medicine is safe and effective when used in children under 10 years.

Other medicines and Janumet

If you need to be given an injection of a contrast agent that contains iodine, for example, in the context of an X-ray or scan, you should stop taking Janumet before or at the time of the injection. Your doctor will decide when you should stop taking Janumet and when you can start taking it again.

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. You may need more frequent blood glucose and kidney function tests, or your doctor may need to adjust the dose of Janumet. It is especially important to mention:

• medicines (taken by mouth, inhaled, or injected) used to treat diseases that cause inflammation, such as asthma and arthritis (corticosteroids)
• medicines that increase urine production (diuretics)
• medicines used to treat pain and inflammation (NSAIDs and COX-2 inhibitors, such as ibuprofen and celecoxib)
• certain medicines used to treat high blood pressure (ACE inhibitors and angiotensin II receptor antagonists)
• medicines used to treat bronchial asthma (beta-2 adrenergic agonists)
• iodinated contrast agents or medicines that contain alcohol
• certain medicines used to treat stomach problems such as cimetidine
• ranolazine, a medicine used to treat angina pectoris
• dolutegravir, a medicine used to treat HIV infection
• vandetanib, a medicine used to treat a specific type of thyroid cancer (medullary thyroid cancer)
• digoxin (for irregular heartbeat and other heart problems). Your doctor may need to check the level of digoxin in your blood if you are taking Janumet.

Taking Janumet with alcohol

Avoid excessive alcohol intake while taking Janumet, as this may increase the risk of lactic acidosis (see section “Warnings and precautions”).

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. You should not take this medicine during pregnancy. You should not take this medicine if you are breast-feeding. See section 2, Do not take Janumet.

Driving and using machines

The ability to drive and use machines may be unaffected or minimally affected by this medicine. However, cases of dizziness and somnolence have been reported during treatment with sitagliptin, which may affect your ability to drive and use machines.

Taking this medicine with sulfonylureas or insulin may cause hypoglycemia, which may affect your ability to drive and use machines or work without a safe support.

Janumet contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially “sodium-free”.

3. How to take Janumet

Take this medicine exactly as your doctor has told you. If you are not sure, ask your doctor or pharmacist.

• Take one tablet:
• • twice a day by mouth
  • with food to reduce the chance of stomach upset

• Your doctor may need to increase the dose to control your blood sugar levels.

• If you have reduced kidney function, your doctor may prescribe a lower dose.

You should continue with the diet recommended by your doctor during treatment with this medicine and be careful to distribute your carbohydrate intake evenly throughout the day.

It is unlikely that treatment with this medicine alone will cause abnormally low blood sugar levels (hypoglycemia). Hypoglycemia may occur when this medicine is taken with a sulfonylurea or insulin, so your doctor may need to reduce the dose of your sulfonylurea or insulin.

If you take more Janumet than you should

If you take more of the prescribed dose of this medicine, contact your doctor immediately. Go to the hospital if you have symptoms of lactic acidosis such as feeling cold or unwell, nausea or vomiting, stomach pain, weight loss, muscle cramps, or rapid breathing (see section “Warnings and precautions”).

If you forget to take Janumet

If you miss a dose, take it as soon as you remember. If you do not remember until the time for your next dose, skip the missed dose and continue with your normal routine. Do not take a double dose of this medicine.

If you stop taking Janumet

Keep taking this medicine for as long as your doctor tells you to, so that you can continue to control your blood sugar levels. Do not stop taking this medicine without talking to your doctor first. If you stop taking Janumet, your blood sugar levels may increase again.

If you have any other questions about the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

STOP taking Janumet and contact a doctor immediately if you notice any of the following serious side effects:

• Severe and persistent stomach pain (which may radiate to the back) with or without nausea and vomiting, as these may be signs of pancreatitis.

Janumet may cause a very rare but very serious side effect called lactic acidosis (see section “Warnings and precautions”). If this happens, you must stop taking Janumet and contact a doctor or the nearest hospital immediately, as lactic acidosis can lead to coma.

If you have a severe allergic reaction (frequency not known), including skin rash, hives, blisters on the skin/peeling of the skin, and swelling of the face, lips, tongue, and throat that may cause difficulty breathing or swallowing, stop taking this medicine and consult your doctor immediately. Your doctor will prescribe a medicine to treat the allergic reaction and change your diabetes medicine.

Some patients who took metformin have experienced the following side effects after starting treatment with sitagliptin:

Common (may affect up to 1 in 10 people): low blood sugar, nausea, gas, vomiting

Uncommon (may affect up to 1 in 100 people): stomach pain, diarrhea, constipation, drowsiness

Some patients have experienced diarrhea, nausea, gas, constipation, stomach pain, or vomiting when starting treatment with the combination of sitagliptin and metformin (frequency classified as common).

Some patients have experienced the following side effects when taking this medicine with a sulfonylurea such as glimepiride:

Very common (may affect more than 1 in 10 people): low blood sugar levels

Common: constipation

Some patients have experienced the following side effects when taking this medicine with pioglitazone:

Common: swelling of hands or feet

Some patients have experienced the following side effects when taking this medicine with insulin:

Very common: low blood sugar levels

Uncommon: dry mouth, headache

Some patients have experienced the following side effects during clinical studies while taking sitagliptin alone (one of the medicines in Janumet) or during use after approval of Janumet or sitagliptin alone or with other diabetes medicines:

Common: low blood sugar levels, headache, upper respiratory tract infection, nasal congestion or runny nose, and sore throat, arthrosis, pain in the arm or leg

Uncommon: dizziness, constipation, itching

Rare: reduced platelet count

Frequency not known: kidney problems (which may require dialysis), vomiting, joint pain, muscle pain, back pain, interstitial lung disease, bullous pemphigoid (a type of blistering skin condition)

Some patients have experienced the following side effects after taking metformin alone:

Very common: nausea, vomiting, diarrhea, stomach pain, and loss of appetite. These symptoms usually occur when you start taking metformin and will normally go away

Common: metallic taste, reduced or low vitamin B12 levels in the blood (the symptoms may include extreme tiredness (fatigue), pain, and redness of the tongue (glossitis), tingling (paresthesia), or pale or yellowish skin). Your doctor may ask for tests to find out the cause of your symptoms because some of them may be caused by diabetes or other health problems not related to this medicine.

Very rare: hepatitis (a liver problem), hives, skin rash, or itching

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist, or nurse, even if it is not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Janumet

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the blister and on the carton after EXP. The expiry date is the last day of the month shown.

Do not store above 25 °C.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help to protect the environment.

6. Package contents and further information

Composition of Janumet

• The active substances are sitagliptin and metformin.

• Each film-coated tablet of Janumet 50 mg/850 mg (tablet) contains sitagliptin phosphate monohydrate equivalent to 50 mg of sitagliptin and 850 mg of metformin hydrochloride.
• Each film-coated tablet of Janumet 50 mg/1,000 mg (tablet) contains sitagliptin phosphate monohydrate equivalent to 50 mg of sitagliptin and 1,000 mg of metformin hydrochloride.

• The other ingredients are:

• Tablet core: microcrystalline cellulose (E460), povidone K 29/32 (E1201), sodium lauryl sulfate and sodium stearyl fumarate.
• Film coating: polyvinyl alcohol, macrogol 3350, talc (E553b), titanium dioxide (E171), red iron oxide (E172) and black iron oxide (E172).

Appearance and package contents

• The film-coated tablets of Janumet 50 mg/850 mg are oval, pink and engraved with "515" on one side.
• The film-coated tablets of Janumet 50 mg/1,000 mg are oval, red and engraved with "577" on one side.

Opaque blisters (PVC/PE/PVDC and aluminum). Packs of 14, 28, 56, 60, 112, 168, 180, 196 film-coated tablets, multipacks containing 196 (2 packs of 98) and 168 (2 packs of 84) film-coated tablets. Pack of 50 x 1 film-coated tablet in a precut unit dose blister.

Not all pack sizes may be marketed.

Marketing authorisation holder and manufacturer

Merck Sharp & Dohme B.V.

Waarderweg 39

2031 BN Haarlem

Netherlands

For further information about this medicine, please contact the local representative of the marketing authorisation holder:

Date of last revision of this leaflet:{MM/AAAA}.

Detailed information on this medicine is available on the European Medicines Agency website: https://www.ema.europa.eu.