Janumet 5. 0 mg/1. Summary of Product Characteristics (SPC)Janumet. Janumet is also indicated as add- on to insulin (i. Posology. The dose of antihyperglycaemic therapy with Janumet should be individualised on the basis of the patient's current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 1. Adults with normal renal function (GFR . When Janumet is used in combination with a sulphonylurea, a lower dose of the sulphonylurea may be required to reduce the risk of hypoglycaemia (see section 4. Greenmedinfo.com - Natural Health Resource - The world's most widely referenced, open access, natural medicine database, with 30,000+ study abstracts and growing daily. Free ebook: Machiavelli's Laboratory "Ethics taught by an unethical scientist" 12,000 BIOMEDICAL ABBREVIATIONS This page is provided "as is", without warranty of any. MSN Health and Fitness has fitness, nutrition and medical information for men and women that will help you get active, eat right and improve your overall wellbeing. Chronic kidney disease (CKD) is an important source of long-term morbidity and mortality. It has been estimated that CKD affects more than 20 million people in the. Update of 2002 Cochrane evidence-based review of Ginkgo biloba for cognitive impairment and dementia found that while safe with no excess adverse effects compared to. Find patient medical information for VITAMIN C ASCORBIC ACID on WebMD including its uses, effectiveness, side effects and safety, interactions, user ratings and. Janumet 50 mg/1000 mg film-coated tablets - Summary of Product Characteristics (SPC) by Merck Sharp & Dohme Limited. Upon completion of this course, you should be able to: Define the various types of renal failure and disease. Describe the impact of renal disease on public health. Find patient medical information for GERMANIUM on WebMD including its uses, effectiveness, side effects and safety, interactions, user ratings and products that have it. The kidneys alone produce about two hundred and fifty grams (about half a pound) of bicarbonate per day in an attempt to neutralize acid in the body. ![]() For patients inadequately controlled on dual combination therapy with the maximal tolerated dose of metformin and a PPAR. When Janumet is used in combination with insulin, a lower dose of insulin may be required to reduce the risk of hypoglycaemia (see section 4. For the different doses on metformin, Janumet is available in strengths of 5. All patients should continue their recommended diet with an adequate distribution of carbohydrate intake during the day. Special populations. Renal impairment. No dose adjustment is needed for patients with mild renal impairment (glomerular filtration rate . A GFR should be assessed before initiation of treatment with metformin- containing products and at least annually thereafter. In patients at increased risk of further progression of renal impairment and in the elderly, renal function should be assessed more frequently, e. Factors that may increase the risk of lactic acidosis (see section 4. GFR < 6. 0 m. L/min. If no adequate strength of Janumet is available, individual monocomponents should be used instead of the fixed- dose combination. GFR m. L/min. Metformin. Sitagliptin. 60- 8. Maximum daily dose is 3. Dose reduction may be considered in relation to declining renal function. Maximum daily dose is 1. Maximum daily dose is 2. The starting dose is at most half of the maximum dose. Maximum daily dose is 5. Maximum daily dose is 1. The starting dose is at most half of the maximum dose.< 3. Metformin is contraindicated. Maximum daily dose is 2. Hepatic impairment. Janumet must not be used in patients with hepatic impairment (see section 5. Elderly. As metformin and sitagliptin are excreted by the kidney, Janumet should be used with caution as age increases. Monitoring of renal function is necessary to aid in prevention of metformin- associated lactic acidosis, particularly in the elderly (see sections 4. Paediatric population. The safety and efficacy of Janumet in children and adolescents from birth to < 1. No data are available. Method of administration. Janumet should be given twice daily with meals to reduce the gastrointestinal adverse reactions associated with metformin. Janumet is contraindicated in patients with: - hypersensitivity to the active substances or to any of the excipients listed in section 6. GFR< 3. 0 m. L/min) (see section 4. General. Janumet should not be used in patients with type 1 diabetes and must not be used for the treatment of diabetic ketoacidosis. Acute pancreatitis. Use of DPP- 4 inhibitors has been associated with a risk of developing acute pancreatitis. Patients should be informed of the characteristic symptom of acute pancreatitis: persistent, severe abdominal pain. Resolution of pancreatitis has been observed after discontinuation of sitagliptin (with or without supportive treatment), but very rare cases of necrotising or haemorrhagic pancreatitis and/or death have been reported. If pancreatitis is suspected, Janumet and other potentially suspect medicinal products should be discontinued; if acute pancreatitis is confirmed, Janumet should not be restarted. Caution should be exercised in patients with a history of pancreatitis. Lactic acidosis. Lactic acidosis, a rare but serious metabolic complication, most often occurs at acute worsening of renal function or cardiorespiratory illness or sepsis. Metformin accumulation occurs at acute worsening of renal function and increases the risk of lactic acidosis. In case of dehydration (severe vomiting, diarrhoea, fever or reduced fluid intake), metformin should be temporarily discontinued and contact with a health care professional is recommended. Medicinal products that can acutely impair renal function (such as antihypertensives, diuretics and NSAIDs) should be initiated with caution in metformin- treated patients. Other risk factors for lactic acidosis are excessive alcohol intake, hepatic insufficiency, inadequately controlled diabetes, ketosis, prolonged fasting and any conditions associated with hypoxia, as well as concomitant use of medicinal products that may cause lactic acidosis (see sections 4. Patients and/or care- givers should be informed of the risk of lactic acidosis. Lactic acidosis is characterised by acidotic dyspnoea, abdominal pain, muscle cramps, asthenia and hypothermia followed by coma. In case of suspected symptoms, the patient should stop taking metformin and seek immediate medical attention. Diagnostic laboratory findings are decreased blood p. H (< 7. 3. 5), increased plasma lactate levels (> 5 mmol/L) and an increased anion gap and lactate/pyruvate ratio. Renal function. GFR should be assessed before treatment initiation and regularly thereafter (see section 4. Janumet is contraindicated in patients with GFR < 3. L/min and should be temporarily discontinued during conditions with the potential to alter renal function (see section 4. Hypoglycaemia. Patients receiving Janumet in combination with a sulphonylurea or with insulin may be at risk for hypoglycaemia. Therefore, a reduction in the dose of the sulphonylurea or insulin may be necessary. Hypersensitivity reactions. Post- marketing reports of serious hypersensitivity reactions in patients treated with sitagliptin have been reported. These reactions include anaphylaxis, angioedema, and exfoliative skin conditions including Stevens- Johnson syndrome. Onset of these reactions occurred within the first 3 months after initiation of treatment with sitagliptin, with some reports occurring after the first dose. If a hypersensitivity reaction is suspected, Janumet should be discontinued, other potential causes of the event should be assessed, and alternative treatment for diabetes should be instituted (see section 4. Surgery. Janumet must be discontinued at the time of surgery under general, spinal or epidural anaesthesia. Therapy may be restarted no earlier than 4. Administration of iodinated contrast agent. Intravascular administration of iodinated contrast agents may lead to contrast- induced nephropathy, resulting in metformin accumulation and an increased risk of lactic acidosis. Janumet should be discontinued prior to or at the time of the imaging procedure and not restarted until at least 4. Change in clinical status of patients with previously controlled type 2 diabetes. A patient with type 2 diabetes previously well controlled on Janumet who develops laboratory abnormalities or clinical illness (especially vague and poorly defined illness) should be evaluated promptly for evidence of ketoacidosis or lactic acidosis. Evaluation should include serum electrolytes and ketones, blood glucose and, if indicated, blood p. H, lactate, pyruvate, and metformin levels. If acidosis of either form occurs, treatment must be stopped immediately and other appropriate corrective measures initiated. Co- administration of multiple doses of sitagliptin (5. Pharmacokinetic drug interaction studies with Janumet have not been performed; however, such studies have been conducted with the individual active substances, sitagliptin and metformin. Concomitant use not recommended. Alcohol. Alcohol intoxication is associated with an increased risk of lactic acidosis, particularly in cases of fasting, malnutrition or hepatic impairment. Iodinated contrast agents Janumet must be discontinued prior to or at the time of the imaging procedure and not restarted until at least 4. Combinations requiring precautions for use. Some medicinal products can adversely affect renal function, which may increase the risk of lactic acidosis, e. NSAIDs, including selective cyclo- oxygenase (COX) II inhibitors, ACE inhibitors, angiotensin II receptor antagonists and diuretics, especially loop diuretics. When starting or using such products in combination with metformin, close monitoring of renal function is necessary. Cationic medicinal products that are eliminated by renal tubular secretion (e. A study conducted in seven normal healthy volunteers showed that cimetidine, administered as 4. AUC) by 5. 0 % and Cmax by 8. Therefore, close monitoring of glycaemic control, dose adjustment within the recommended posology and changes in diabetic treatment should be considered when cationic medicinal products that are eliminated by renal tubular secretion are co- administered. Glucocorticoids (given by systemic and local routes) beta- 2- agonists, and diuretics have intrinsic hyperglycaemic activity. The patient should be informed and more frequent blood glucose monitoring performed, especially at the beginning of treatment with such medicinal products. If necessary, the dose of the anti- hyperglycaemic medicinal product should be adjusted during therapy with the other medicinal product and on its discontinuation. ACE- inhibitors may decrease the blood glucose levels. If necessary, the dose of the anti- hyperglycaemic medicinal product should be adjusted during therapy with the other medicinal product and on its discontinuation. Effects of other medicinal products on sitagliptin. In vitro and clinical data described below suggest that the risk for clinically meaningful interactions following co- administration of other medicinal products is low. In vitro studies indicated that the primary enzyme responsible for the limited metabolism of sitagliptin is CYP3. A4, with contribution from CYP2. C8. In patients with normal renal function, metabolism, including via CYP3. A4, plays only a small role in the clearance of sitagliptin. VITAMIN C ASCORBIC ACID: Uses, Side Effects, Interactions and Warnings. Vitamin C is a vitamin. Some animals can make their own vitamin C, but people must get this vitamin from food and other sources. Good sources of vitamin C are fresh fruits and vegetables, especially citrus fruits. Vitamin C can also be made in a laboratory. Most experts recommend getting vitamin C from a diet high in fruits and vegetables rather than taking supplements. Fresh- squeezed orange juice or fresh- frozen concentrate is a better pick than ready- to- drink orange juice. The fresh juice contains more active vitamin C. Drink fresh- frozen orange juice within one week after reconstituting it for the most benefit. It you prefer ready- to- drink orange juice, buy it 3 to 4 weeks before the expiration date, and drink it within one week of opening. Historically, vitamin C was used for preventing and treating scurvy. Scurvy is now relatively rare, but it was once common among sailors, pirates, and others who spent long periods of time onboard ships. When the voyages lasted longer than the supply of fruits and vegetables, the sailors began to suffer from vitamin C deficiency, which led to scurvy. These days, vitamin C is used most often for preventing and treating the common cold. Some people use it for other infections including gum disease, acne and other skin infections, bronchitis, human immunodeficiency virus (HIV) disease, stomach ulcers caused by bacteria called Helicobacter pylori, tuberculosis, dysentery (an infection of the lower intestine), and skin infections that produce boils (furunculosis). It is also used for infections of the bladder and prostate. Some people use vitamin C for depression, thinking problems, dementia, Alzheimer's disease, physical and mental stress, fatigue, and attention deficit- hyperactivity disorder (ADHD). Other uses include increasing the absorption of iron from foods and correcting a protein imbalance in certain newborns (tyrosinemia). There is some thought that vitamin C might help the heart and blood vessels. It is used for hardening of the arteries, preventing clots in veins and arteries, heart attack, stroke, high blood pressure, and high cholesterol. Vitamin C is also used for glaucoma, preventing cataracts, preventing gallbladder disease, dental cavities (caries), constipation, Lyme disease, boosting the immune system, heat stroke, hay fever, asthma, bronchitis, cystic fibrosis, infertility, diabetes, chronic fatigue syndrome (CFS), autism, collagen disorders, arthritis and bursitis, back pain and disc swelling, cancer, and osteoporosis. Additional uses include improving physical endurance and slowing aging, as well as counteracting the side effects of cortisone and related drugs, and aiding drug withdrawal in addiction. Sometimes, people put vitamin C on their skin to protect it against the sun, pollutants, and other environmental hazards. Vitamin C is also applied to the skin to help with damage from radiation therapy. How does it work? Vitamin C is required for the proper development and function of many parts of the body. It also plays an important role in maintaining proper immune function.
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