Janumet XR is a prescription medication used to treat type 2 diabetes mellitus in adults. It is a combination product containing two active ingredients: sitagliptin and metformin.

How Does Janumet XR Work?

Janumet XR works by targeting multiple pathways involved in the regulation of blood sugar levels in individuals with type 2 diabetes. Sitagliptin works by inhibiting the enzyme DPP-4, which in turn increases the levels of incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). These hormones stimulate the release of insulin from the pancreas and inhibit the release of glucagon, resulting in lower blood sugar levels. Metformin works by decreasing the amount of glucose produced by the liver and increasing the sensitivity of muscle cells to insulin, allowing for better uptake of glucose from the bloodstream.

Precautions and Warnings of Janumet XR

Janumet XR is a prescription medicine that is only available with a prescription. Please advise your healthcare provider of all your medical history and current health status.

Contraindications

Janumet XR is contraindicated in patients with:

• Known hypersensitivity to sitagliptin, metformin, or any other components of the formulation.

• Severe renal impairment (eGFR less than 30 mL/min/1.73 m²) or end-stage renal disease.

• Acute or chronic metabolic acidosis, including diabetic ketoacidosis.

• History of lactic acidosis or conditions predisposing to lactic acidosis such as sepsis or severe dehydration.

• Use of iodinated contrast agents in patients with an eGFR between 30 and 60 mL/min/1.73 m².

Special Populations

Renal Impairment: Use with caution in patients with renal impairment.

Hepatic Impairment: Use with caution in patients with hepatic impairment.

Elderly Patients: Consider age-related decreases in renal function when prescribing Janumet XR to elderly patients.

Janumet XR Side Effects

While Janumet XR is generally well-tolerated, like any medication, it may cause side effects in some individuals. Side effects associated with Janumet XR may include:

Common Side Effects

• Stuffy or runny nose
• Sore throat
• Upper respiratory infection
• Diarrhea
• Nausea
• Vomiting
• Gas
• Stomach discomfort
• Abdominal pain
• Indigestion
• Weakness
• Headache
• Swelling of extremities
• Low blood sugar (hypoglycemia) when used in combination with certain medications, such as a sulfonylurea or insulin.

Serious Side Effects

• Hives
• Difficulty breathing
• Swelling of your face, lips, tongue, or throat
• Joint pain
• Change in the amount of urine
• Unusual skin blisters
• Shortness of breath
• Swelling ankles or feet
• Unusual tiredness
• Sudden weight gain
• Severe stomach pain that may spread to the back
• Persistent nausea or vomiting
• Sudden sweating
• Shaking
• Fast heartbeat
• Hunger
• Blurred vision
• Dizziness
• Tingling in the hands or feet
• Increased thirst
• Increased urination
• Confusion
• Drowsiness
• Flushing
• Rapid breathing
• Fruity breath odor
• Severe dizziness

Janumet XR Drug Interactions

Janumet XR may interact with other medications, supplements, or substances, potentially affecting its effectiveness or increasing the risk of adverse effects. According to MedBroadcast, some notable drug interactions with Janumet XR include:

• Acetazolamide
• Alcohol
• Angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• Antipsychotics (e.g., clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• β2-agonists (e.g., salbutamol, formoterol)
• Basiliximab
• Birth control pills (e.g., Angeliq and Yaz)
• Brinzolamide
• Buserelin
• Calcium channel blockers (e.g., amlodipine (Norvasc), diltiazem (Tiazac XC), nifedipine, verapamil)
• Cephalexin (e.g., Keflex)
• Chloroquine
• Cimetidine
• Inhaled corticosteroids (e.g., budesonide (Entocort), ciclesonide (Alvesco), fluticasone (Flovent Diskus))
• Oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• Cyproterone
• Danazol
• Other diabetes medications (e.g., acarbose, canagliflozin (Invokana), glyburide, insulin, metformin, rosiglitazone)
Digoxin
• Disopyramide
• Diuretics (water pills; e.g., hydrochlorothiazide, furosemide, amiloride, triamterene)
• Dorzolamide
• Epinephrine (e.g. EpiPen)
• Estrogens (e.g., conjugated estrogen, estradiol (Vagifem), ethinyl estradiol)
• Everolimus
• Goserelin
• Glucagon
• Glycopyrrolate
• Hepatitis C antivirals (e.g., elbasvir, glecaprevir, ledipasvir, pibrentasvir, voxilaprevir)
• HIV integrase inhibitors (e.g., bictegravir, dolutegravir (Tivicay))
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir (Norvir), saquinavir)
• Hydroxychloroquine (e.g., Plaquenil)
• Iodinated contrast material
• Isoniazid
• Lamotrigine (e.g., Lamictal)
• Lanreotide
• Leuprolide
• Mifepristone
• Monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• Nicotinic acid
• Nilotinib
• Non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac (Voltaren), ibuprofen, ketorolac, naproxen)
• Octreotide
• Ondansetron (e.g. Zofran)
• Pasireotide
• Pegvisomant
• Progestins (e.g., dienogest (Visanne), levonorgestrel, medroxyprogesterone, norethindrone)
Quinine
• Quinolone antibiotics (e.g., ciprofloxacin, levofloxacin (Levaquin), moxifloxacin (Vigamox))
• Ranolazine
• St. John’s wort
• Salicylates (e.g., ASA)
• Selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine (Prozac), paroxetine, sertraline (Zoloft))
• Sirolimus
• Somatropin
• “Statin” anticholesterol medications (e.g., atorvastatin (Lipitor), lovastatin, simvastatin)
• Sulfonamides (e.g., sulfamethoxazole)
• Sunitinib
• Tacrolimus
• Testosterone
• Thyroid replacements (e.g., desiccated thyroid, levothyroxine (Synthroid))
• Topiramate
• Tramadol
Trimethoprim
• Trospium
Warfarin
• Vandetanib
• Vorinostat

Strengths and Dosages of Janumet XR

Available Strengths

• Sitagliptin 50 mg/Metformin extended-release 500 mg
• Sitagliptin 50 mg/Metformin extended-release 1000 mg

Recommended Dosages

The usual starting dose is one tablet once daily with meals. Dosage adjustments may be necessary based on renal function, with lower doses recommended for patients with moderate to severe renal impairment (eGFR less than 60 mL/min/1.73 m²).

The maximum recommended daily dose of sitagliptin is 100 mg and the maximum recommended daily dose of metformin is 2000 mg.

Cost of Janumet XR in America

At this time of writing, the cost for Janumet XR oral tablet, extended release (1000 mg-50 mg) to be approximately $613 for a supply of 60 tablets.

Patients are encouraged to check with their local pharmacies, insurance providers, or explore patient assistance programs to determine the most cost-effective option for obtaining Janumet XR.

Why is Janumet XR so Expensive?

Research and Development Costs: Pharmaceutical companies invest significant resources in the research and development of new medications. This includes conducting clinical trials, obtaining regulatory approval, and ensuring product safety and efficacy. These costs are often passed on to consumers through drug pricing.

Patent Protection: Brand-name medications like Janumet XR are protected by patents, which grant the manufacturer exclusive rights to produce and sell the drug for a certain period. During this time, generic versions of the medication cannot enter the market, allowing the manufacturer to set higher prices without competition.

Marketing and Promotion: Pharmaceutical companies spend substantial amounts on marketing and promotional activities to promote their brand-name medications to healthcare providers and consumers. These marketing costs, including advertising campaigns and sales representatives, contribute to the overall expense of the medication.

Manufacturing and Distribution Costs: Manufacturing and distributing medications, especially complex formulations like Janumet XR, require specialized facilities and equipment, as well as adherence to strict quality control standards. These manufacturing and distribution costs are factored into the pricing of the medication.

Demand and Supply Dynamics: The demand for Janumet XR and other diabetes medications is influenced by factors such as the prevalence of diabetes, patient demographics, and treatment guidelines. Limited competition and high demand for the medication can lead to higher prices.

Janumet XR Alternatives

While Janumet XR is a commonly prescribed medication for the management of type 2 diabetes, there are several alternative medications available that healthcare providers may consider based on individual patient factors and treatment goals:

Metformin: Metformin is often considered the first-line treatment for type 2 diabetes. It works primarily by decreasing hepatic glucose production and increasing insulin sensitivity in peripheral tissues, such as muscle and fat cells.

DPP-4 Inhibitors: Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin (the active ingredient in Janumet XR), saxagliptin (Onglyza), linagliptin (Trajenta), and alogliptin, are oral medications that help lower blood sugar levels by inhibiting the enzyme DPP-4.

GLP-1 Receptor Agonists: Glucagon-like peptide-1 (GLP-1) receptor agonists are injectable medications that mimic the effects of GLP-1 (such as Ozempic and Zepbound), a naturally occurring hormone that stimulates insulin secretion and inhibits glucagon release.

SGLT-2 Inhibitors: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors, such as dapagliflozin, canagliflozin (Invokana), and empagliflozin (Jardiance), are oral medications that work by inhibiting the reabsorption of glucose in the kidneys, leading to increased urinary glucose excretion.

Sulfonylureas: Sulfonylureas, such as glipizide, glyburide, and glimepiride, are oral medications that stimulate insulin secretion from pancreatic beta cells. These medications can help lower blood sugar levels in patients with type 2 diabetes by increasing insulin production.

Thiazolidinediones (TZDs): Thiazolidinediones, such as pioglitazone and rosiglitazone, are oral medications that improve insulin sensitivity by activating peroxisome proliferator-activated receptor gamma (PPAR-gamma) receptors in adipose tissue, muscle, and liver.

FAQs About Janumet XR

Why take Janumet XR in the evening?

Janumet XR is often taken in the evening with meals to optimize its effectiveness. By taking it with the evening meal, it helps to control blood sugar levels throughout the night and into the morning, which can contribute to better glycemic control throughout the day.

What is Janumet XR?

Janumet XR is a prescription medication used to treat type 2 diabetes. It contains two active ingredients: sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, and metformin, a biguanide antidiabetic agent.

How does Janumet XR work?

Janumet XR works by targeting multiple pathways involved in the regulation of blood sugar levels. Sitagliptin helps increase insulin secretion and decrease glucagon production in response to meals, while metformin reduces glucose production in the liver and improves insulin sensitivity in peripheral tissues.

How long does Janumet XR stay in your system?

The duration of action of Janumet XR varies depending on individual factors such as metabolism and renal function. Generally, Janumet XR is designed for once-daily dosing, providing sustained release of the medication over a 24-hour period.

What is Janumet XR used for?

Janumet XR is indicated for the management of type 2 diabetes mellitus in adults. It is used to improve glycemic control in combination with diet and exercise, either as monotherapy or in combination with other antidiabetic medications.

What is the best time of day to take Janumet XR?

The best time of day to take Janumet XR is typically in the evening with the evening meal.

When will Janumet XR patent expire?

As reported by Merck, Janumet XR is currently protected by two patents in the United States. The first, U.S. Patent No. 7,326,708, covers the dihydrogen phosphate salt of sitagliptin and is set to expire on Nov. 24, 2026, with pediatric exclusivity extending to May 24, 2027. The second, U.S. Patent No. 8,414,921, covers the co-formulation of sitagliptin and metformin found in JANUMET and is set to expire on Jan. 21, 2029, with pediatric exclusivity extending to July 21, 2029. After patent expiration, generic versions of Janumet XR may become available, potentially reducing medication costs for consumers.

What are the side effects of Janumet XR?

Common side effects of Janumet XR include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal discomfort. Serious side effects may include hypoglycemia, pancreatitis, and allergic reactions. It is essential to discuss any side effects with your healthcare provider.

What is the equivalent of Janumet XR?

The equivalent of Janumet XR may vary depending on individual patient factors and treatment goals. Alternative medications for the management of type 2 diabetes include combinations of sitagliptin with metformin immediate-release tablets, as well as other DPP-4 inhibitors and metformin combinations.

Who makes Janumet XR?

Janumet XR is a trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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