Indications and Usage for Janumet XR JANUMET® XR is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both sitagliptin and metformin extended-release is appropriate. Important Limitations of Use Janumet XR should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Janumet XR has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using Janumet XR. Janumet XR Dosage and Administration Recommended Dosing The dose of Janumet XR should be individualized on the basis of the patient’s current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 100 mg sitagliptin and 2000 mg metformin.
Initial combination therapy or maintenance of combination therapy should be individualized and left to the discretion of the healthcare provider. In patients not currently treated with metformin, the recommended total daily starting dose of Janumet XR is 100 mg sitagliptin and 1000 mg metformin hydrochloride (HCl) extended-release. Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose. In patients already treated with metformin, the recommended total daily starting dose of Janumet XR is 100 mg sitagliptin and the previously prescribed dose of metformin. For patients taking metformin immediate-release 850 mg twice daily or 1000 mg twice daily, the recommended starting dose of Janumet XR is two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets taken together once daily.
Maintain the same total daily dose of sitagliptin and metformin when changing between JANUMET (sitagliptin and metformin HCl immediate-release) and Janumet XR. Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose. Janumet XR should be administered with food to reduce the gastrointestinal side effects associated with the metformin component. Janumet XR should be given once daily with a meal preferably in the evening. Janumet XR should be swallowed whole.
The tablets must not be split, crushed, or chewed before swallowing. There have been reports of incompletely dissolved Janumet XR tablets being eliminated in the feces. It is not known whether this material seen in feces contains active drug. If a patient reports repeatedly seeing tablets in feces, the healthcare provider should assess adequacy of glycemic control [see Patient Counseling Information (17.1)]. The 100 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablet should be taken as a single tablet once daily. Patients using two Janumet XR tablets (such as two 50 mg sitagliptin/500 mg metformin hydrochloride extended-release tablets or two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets) should take the two tablets together once daily. C
oadministration of Janumet XR with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia No studies have been performed specifically examining the safety and efficacy of Janumet XR in patients previously treated with other oral antihyperglycemic agents and switched to Janumet XR. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring as changes in glycemic control can occur.
Dosage Forms and Strengths 100 mg/1000 mg tablets are blue, bi-convex oval, film-coated tablets with “81” debossed on one side. 50 mg/500 mg tablets are light blue, bi-convex oval, film-coated tablets with “78” debossed on one side. 50 mg/1000 mg tablets are light green, bi-convex oval, film-coated tablets with “80” debossed on one side.
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