DRUG INDEX AS OF APRIL 11, 2014Gabriel Gerardo N. Cortez (Batch 2015)Levitiracetam (Keppra)Diazepam (Valium)CiticolineLactuloseAtorvastatinPiperacillin-TazobactamCefuroximeDexamathasonePantoprazoleClonidine (Catapres)NimodipineFurosemideAcetylcysteine (Fluimucil)VerapamilRosuvastatinIvabradine (Coralan)TramadolNeuropeptide (Cerebrolysin)MannitolParacetamol (Biogesic)OmeprazoleBisacodyl (Dulcolax)Insulin Glargine (Lantus)NicardipineHeparinWarfarin (Coumadin)AmlodipineFondaparinuxEnoxaparin

DRUGSMOAINDICATIONDOSAGECONTRAINDICATIONADVERSE EFFECTS

LEVETIRACETAM(Keppra)Anticonvulsant used in the treatment of partial seizures. The precise mechanism of anticonvulsant effect is unknown.Monotherapy in the treatment of partial onset seizures w/ or w/o secondary generalization in patients 16 yr w/ newly diagnosed epilepsy. Adjunctive therapy in the treatment of partial onset seizures w/ or w/o secondary generalization in adults & childn 4 yr w/ epilepsy; myoclonic seizures in adults & adolescents 12 yr w/ juvenile myoclonic epilepsy & primary generalized tonic-clonic seizures in adults & childn 4 yr w/ idiopathic generalized epilepsy.MonotherapyAdult & adolescent 16 yrInitially 250 mg bid, increased to 500 mg bid after 2 wk. May be further increased by 250 mg bid 2 wkly. Max: 1,500 mg bid.Add-on therapyAdult (18 yr) & adolescent 12-17 yr 50 kgInitially 500 mg bid, may be increased up to 1,500 mg bid. Dose may be titrated by increment/decrement of 500 mg bid 2-4 wkly.Childn & adolescent 50 kgAdult dose,4-17 yr 10 mg/kg bid 2 wkly.Childn 25 kgStart the treatment w/ 100 mg/mL oral soln.Hypersensitivity to levetiracetam or other pyrrolidone derivatives.Nasopharyngitis, somnolence, headache, fatigue & dizziness. Anorexia; depression, hostility/aggression, anxiety, insomnia, nervousness/irritability; convulsion, balance disorder, tremor, lethargy; vertigo; cough; abdominal pain, diarrhea, dyspepsia, vomiting, nausea; rash; asthenia.

DIAZEPAM(Valium)Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.Tab: Symptomatic relief of anxiety, agitation & tension due to psychoneurotic states & transient situational disturbances. Adjunctively in major mental & organic disorders. Adjunct for the relief of reflex muscle spasm due to local trauma. To combat spasticity arising from damage to spinal & supraspinal interneurons. Inj: Basal sedation before stressful therapeutic measures or interventions. For pre-op medication of anxious or tense patients. In psychiatry, treatment of excitation states associated w/ acute anxiety & panic. Motor unrest & delirium tremens. Status epilepticus & other convulsive states. Adjunct for relief of reflex muscle spasm due to local trauma. To combat spasticity arising from damage to spinal & supraspinal interneurons.TabAdult5-20 mg daily.Elderly the usual adult dose.Childn0.1-0.3 mg/kg body wt daily.InjIndividualized dosage.Dependence on other substances including alcohol except in management of acute w/drawal reactions. Severe chronic hypercapnia.Blurred vision, urinary retention (infrequent). Paradoxical reactions. Dependence, w/drawal symptoms.

CITICOLINE NaCiticoline increases blood flow and O2consumption in the brain. It is also involved in the biosynthesis of lecithin.Acute and recovery phase of cerebral infarction (eg, ischemia due to stroke). Cognitive dysfunction due to degenerative (ie, Alzheimer's disease) and cerebrovascular disease. Cerebral insufficiency (eg, dizziness, memory loss, poor concentration, disorientation) due to head trauma or brain injury.Tablet:Usual Dose: 500 mg once or twice daily.Drops:Usual Dose: 100-200 mg (1-2 mL) twice or thrice daily.Ampoule:125 mg/mL: Usual Dose: 1-2 injections daily. 250 mg/mL: Usual Dose: 1 injection daily.Adjust dose according to disease severity. Can be administered through IM or IV (3-5 min) route and IV drip (infusion rate of 40-60 drops/min). Direct IV administration should be made very slowly to prevent episodes of hypotension. Cholinerv is compatible with hypertonic glucose solution and all IV isotonic solutions.Patients with hypertonia of the parasympathetic nervous system.Gastrointestinal disorders (ie, stomach pain, diarrhea). Vascular side effects (ie, hypotension, tachycardia, bradycardia).

LACTULOSELactulose promotes peristalsis by producing an osmotic effect in the colon with resultant distention. In hepatic encephalopathy, it reduces absorption of ammonium ions and toxic nitrogenous compounds, resulting in reduced blood ammonia concentrations.Relief of constipation including chronic constipation. Portal systemic encephalopathy: Hepatic coma or precoma stages where hyperammonemia is present.Constipation:Dosage can vary widely with the severity of the condition. A relatively large initial dose should be followed by a smaller maintenance dose after the first 3 days of treatment. Only 1 daily dose needs to be taken, preferably after breakfast.Adults:Initially 15-30 mL as a single dose or in 2 divided doses.Children 5-10 years:10 mL twice daily;1-5 years:5 mL twice daily.Hepatic Encephalopathy:30-50 mL 3 times a day, subsequently adjusted to produce 2 or 3 soft stools daily.Patients who require a low lactose diet; with galactosemia or disaccharide deficiency; with intestinal obstruction.Initial doses of lactulose may cause abdominal discomfort associated with flatulence and intestinal cramps. These symptoms normally disappear under continued therapy.Nausea and vomiting have occasionally been reported following high doses.Prolonged use or excessive dosage can lead to diarrhea with potential complications eg, loss of fluids, hypokalemia and hyponatremia.

ATORVASTATIN Ca(Avamax)Atorvastatin competitively inhibits HMG-CoA reductase, the enzyme that catalyses the conversion of HMG-CoA to mevalonic acid. This results in the induction of the LDL receptors, leading to lowered LDL-cholesterol concentration.Reduces LDL-cholesterol, apolipoprotein B & triglycerides; increases HDL-cholesterol in the treatment of hyperlipidemias. Adjunct therapy in patients w/ homozygous familial hypercholesterolemia who have some LDL-receptor function. Primary prophylaxis of CV events in patients w/ multiple risk factors.Dose range: 10-80 mg once daily. Doses may be given any time of the day. Dosage should be individualized according to baseline LDL-cholesterol levels, goal of therapy & patient response.Primary hypercholesterolemia & combined hyperlipidemia10 mg once daily.Homozygous familial hypercholesterolemia80 mg.Active liver disease or unexplained persistent elevations of serum transaminases. Pregnancy, women of childbearing potential, lactation.Chest pain, face edema, fever, neck rigidity, malaise, photosensitivity reaction, generalized edema. Nausea & vomiting, gastroenteritis, colitis, gastritis, dry mouth. Arthritis, leg cramps, bursitis, tenosynovitis, myasthenia, tendinous contracture, myositis. Anaphylaxis, angioneurotic edema, bullous rashes (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), rhabdomyolysis & fatigue.

PIPERACILLIN-TAZOBACTAMPiperacillin has an antimicrobial activity against a wide range of gm-ve organisms includingK. pneumoniae,P. aeruginosa,Enterobacteriaceaeand against gm+ve organisms egE. faecalisandB. fragilis. Tazobactam is a penicillanic acid sulfone derivative with beta-lactamase inhibitory properties. In combination, tazobactam enhances the activity of piperacillin against beta-lactamase-producing bacteria.Treatment of documented multidrug resistant gm -ve infections due to organisms proven or suspected to be susceptible to piperacillin-tazobactam except CNS infections; polymicrobial infections eg mixed aerobic & anaerobic infections except CNS infections in which other agents have insufficient activity or are contraindicated due to toxic potential.Adult4 g/500 mg 8 hrly. May be increased up to 4 g/500 mg 6 hrly.Childn >12 yr240 mg/30 mg to 320 mg/40 mg/kg/day in 3-4 divided doses.Hypersensitivity to -lactams including penicillins & cephalosporins or -lactamase inhibitors.Hypotension; diarrhea, nausea, vomiting; rash, erythema, pruritus, urticaria; arthralgia, muscle weakness, myalgia.

CEFUROXIMECefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.Treatment of susceptible infections which include bone & joint infections, bronchitis & other lower resp tract infections, gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infections (including soft tissue infections) & UTI. Inj: Prophylaxis for surgical infection.Oral suspOtitis mediaChildn >2 yr250 mg or 15 mg/kg bid. Max: 500 mg daily.Childn >3 mth125 mg or 10 mg/kg bid. Max: 250 mg daily.IV/IMAdult750 mg tid, may be increased to 1.5 g tid IV in severe infections. Administration may be increased to 6 hrly, if necessary. Total dose: 3-6 g daily.Infant & childn30-60 mg/kg/day, may be increased to 100 mg/kg daily in 3-4 divided doses.Hypersensitivity to cephalosporins.Diarrhea & nausea. Oral susp: Vomiting. Mild to moderate hearing loss. Inj: Transient pain at IM inj site; skin rashes (maculopapular & urticaria), drug fever; pseudomembranous colitis; decreased Hb conc &/or eosinophilia, leukopenia & neutropenia; transient rise in SGOT, SGPT & bilirubin.

DEXAMETHASONEDexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. It suppresses normal immune response.Inflammatory & allergic conditions responsive to corticosteroid therapy eg skin diseases, collagen diseases, blood dyscrasia, certain neoplastic disease & adrenocortical insufficiency.RA, chronic bronchial asthmaTab1-2 tab daily.Forte tab- tab every other day.Disseminated lupus erythematosus, pemphigus, sarcoidosisTab4-9 tab daily.Forte tab1-2 tab every other day.Acute rheumatic fever, severe allergic reactionsTab8-20 tab daily.Forte tab2-5 tab every other day.Acute leukemia, nephrotic syndrome, acute pemphigusTab20-30 tab daily.Forte tab5-7 tab every other day.Tablet/Forte Tablet:Hypersensitivity to prednisolone or to any of the excipients of Decilone/Decilone Forte.Systemic fungal infections; gastrointestinal ulcer; acute or chronic infections; osteoporosis, diabetes mellitus; renal insufficiency; hypertension; history of psychotic illness; immediately before prophylactic immunization.Excessive mental stimulation, increase appetite, muscle twitching, wt gain, tachycardia, insomnia & psychic disturbances.

PANTOPRAZOLE (Prazole IV)Pantoprazole is a substituted benzimidazole, and also known as PPI due to its property to block the final step of acid secretion by inhibiting H+/K+ATPase enzyme system in gastric parietal cell. Both basal and stimulated acid are inhibited.Treatment of GERD, duodenal & gastric ulcer.40 mg IV once daily for 7 days.Occasionally headache or diarrhea. Isolated cases of edema, blurred vision, fever, dizziness, thrombophlebitis, depression or myalgia subsiding after termination of therapy.

CLONIDINE HCl(Catapres)Clonidine stimulates alpha-2 receptors in brain stem which results in reduced sympathetic outflow from the CNS and a decrease in peripheral resistance leading to reduced BP and pulse rate. It does not alter normal haemodynamic response to exercise at recommended dosages.HTN of any etiology except the pheochromocytoma form.TabMild to moderate HTN75-150 mcg bid.Severe HTNIncrease single dose to 300 mcg. Could be repeated up to tid (900 mcg).Infusion0.2 mcg/kg/min IV infusion, not >150 mcg/infusion.Sick sinus syndrome.Dizziness, headache, paresthesia, sedation, gynecomastia, confusion state, delusional perception, depression, hallucination, decreased libido, nightmare, sleep disorder, accommodation disorder, decreased lacrimation, AV block, bradyarrhythmia, sinus bradycardia, orthostatic hypotension. Raynaud's phenomenon, nasal dryness, alopecia, pruritus, rash, urticaria, erectile dysfunction, fatigue, malaise, colonic pseudo-obstruction, constipation, dry mouth, nausea, salivary gland pain, vomiting.

NIMODIPINENimodipine inhibits inflow of calcium ions into cells by blocking calcium channels or select voltage-sensitive areas resulting in relaxation of vascular smooth muscle. Nimodipine has greater action on the cerebral vessels because of its high lipophilicity.Prevention & treatment of ischemic neurological deficits following aneurysmal subarachnoid hemorrhage.Initially 1 mg/hr for 2 hr, increased to 2 mg/hr (provided that no severe hypotension occurs).Patients weighing 2 hrly. Doses >50 mg may be given by slow IV infusion.Pulmonary edemaInitially 40 mg slow IV, increased to 80 mg.Childn0.5-1.5 mg/kg daily. Max: 20 mg daily.Renal failure associated w/ hepatic coma & caused by nephrotoxic or hepatotoxic drugs. Precomatose states associated w/ liver cirrhosis.Fluid & electrolyte imbalance including hyponatremia, hypokalemia & hypochloremic alkalosis; increased urinary excretion of Ca; nephrocalcinosis in preterm infants.

ACETYLCYSTEINE(Fluimucil)Acetylcysteine may decrease the viscosity of secretions by splitting of disulphide bonds in mucoproteins. It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage.Acute & chronic resp tract infections w/ abundant mucus secretions due to acute bronchitis, chronic bronchitis & its exacerbations, pulmonary emphysema, mucoviscidosis & bronchiectasis.Effervescent tab/Oral solnAdult600 mg daily (preferably in the evening) or 200 mg bid-tid.Childn100 mg bid-qid according to age. Dissolve the tab or content of sachet in a glass of water (75 mL).InhalantNebulize 1 amp once-bid for 5-10 days.IM inj1 amp once-bid.Small childn adult dose.IVAdult1 amp bid up to 2-3 amp bid-tid.Childn1-1 amp bid-tid. It is recommended to dilute IV inj w/ 0.9% NaCl soln or a 5% glucose soln.Effervescent tab/Oral soln: Phenylketonurics.Rarely, urticaria, bronchospasm, nausea, vomiting. Inhalant: Rhinitis, stomatitis.

VERAPAMILVerapamil inhibits entry of calcium ions into arterial smooth muscle cells as well as the myocytes and conducting tissue. These actions lead to reversal and preventions of coronary artery spasm, reduction in afterload through peripheral vasodilatation and reduction in ventricular rate in patients with chronic atrial flutter or fibrillation and reduction in the occurrence of paroxysmal supraventricular tachycardia. Verapamil reduces BP, relieves angina and slows AV conduction.Control of supraventricular arrhythmias & management of angina pectoris & HTN.Adult & adolescent >50 kg body wtCHD, paroxysmal, supraventricular tachycardia, atrial fibrillation/flutter-1 tab bid.HTN1 tab in the morning, may add -1 tab in the evening if not sufficient. Max: 480 mg daily (long-term therapy).CV shock, acute MI w/ complications eg bradycardia, hypotension, left-sided heart failure, pronounced conduction disturbances eg 2nd- & 3rd-degree SA or AV block, sick sinus syndrome, manifest cardiac insufficiency, atrial fibrillation/flutter & simultaneous existing Wolff-Parkinson-White syndrome. Angina pectoris 60 beats/min. Treatment of chronic heart failure: Reduction of CV events (CV mortality or hospitalization for worsening heart failure) in adults in sinus rhythm w/ symptomatic chronic heart failure & whose heart rate is 70 beats/min.5 mg bid. After 1 mth, increase to 7.5 mg bid.Elderly2.5 mg morning & evening.Resting heart rate 16 yr1-2 tab 4-6 hrly. Max: 8 tab/day.Hypersensitivity to codeine or opioids. Acute intoxication w/ alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids or psychotropic drugs. Opioid-dependent patients, chronic alcoholism. Lactation.Dizziness, nausea, somnolence. Asthenia, fatigue, hot flushes, headache, tremor, abdominal pain, constipation, diarrhea, dyspepsia, flatulence, dry mouth, vomiting, anorexia, anxiety, confusion, euphoria, insomnia, nervousness, pruritus, rash, increased sweating.

PANTOPRAZOLE + DOMPERIDONE (Prazole Plus)Pantoprazole is a substituted benzimidazole, and also known as PPI due to its property to block the final step of acid secretion by inhibiting H+/K+ATPase enzyme system in gastric parietal cell. Both basal and stimulated acid are inhibited. Domperidone is a peripheral dopamine-receptor blocker. It increases oesophageal peristalsis, lower oesophageal sphincter pressure, gastric motility and peristalsis, thus facilitating gastric emptying and decreasing small bowel transit time.Symptomatic management of burning in various acid peptic disorders associated w/ nausea & vomiting; GERD, reflux esophagitis, non-ulcer dyspepsia, gastroparesis & idiopathic hiccup or any other peptic disease accompanied by nausea &/or vomiting eg acute gastritis including that induced by NSAIDs.1 cap daily.Pregnancy & lactation.Headache, diarrhea, skin rashes. Pantoprazole: Pruritus & dizziness. Domperidone: Galactorrhea (in females) & gynecomastia (in males); dry mouth, thirst, nervousness, drowsiness & itching.

REBAMIPIDE (Mucosta)Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow, prostaglandin biosynthesis and decrease free oxygen radicals.Treatment of gastric mucosal lesions (erosion, bleeding, redness & edema) in acute gastritis & exacerbation of chronic gastritis; gastric ulcer. Prevention of NSAID-induced gastropathy.Gastric mucosal lesions in acute gastritis & exacerbation of chronic gastritis & gastric ulcer1 tab tid to be taken in the morning, evening & before bedtime.Rarely hypersensitivity reactions; GI disturbances; increased SGOT, SGPT, -glutamyl transferase, alkaline phosphatase & BUN levels; leukopenia; mammary gland expansion, nonpuerperal lactation, menstrual disorder, dizziness, edema & foreign body feeling in the pharynx.

BETAHISTINE (Serc)Betahistine improves the microcirculation in the labyrinth which reduces endolymphatic pressure.Meniere's disease, Meniere-like syndrome characterized by attacks of vertigo, tinnitus & sensorineural deafness, peripheral vertigo.Adult24-48 mg/day in divided doses.8-mg tab1-2 tab tid;16-mg tab-1 tab tid.24-mg tab1 tab bid.Hypersensitivity.Mild gastric complaints.

NIFEDIPINE (Calcibloc)Nifedipine blocks the slow calcium channels thus preventing the flow of calcium ions into the cell. It produces peripheral and coronary vasodilatation, reduces afterload, peripheral resistance and BP, increases coronary blood flow and causes reflex tachycardia. It has little or no effect on cardiac conduction and rarely has negative inotropic activity.All forms of HTN; HTN in pregnancy; coronary insufficiency w/ or w/o angina; vasospastic angina, to increase heart rate in sinus bradycardia & sick sinus syndrome.Adult5-10 mg bid-tid.Acute MI.Infrequently, flushing, nausea, dizziness, headache, tiredness, sedation; leg edema.

LOSARTAN (Lifezar)Losartan is an angiotensin II receptor antagonist. The drug and its active metabolite selectively block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively antagonising its binding to AT1receptors.Treatment of HTN, alone or in combination w/ other antihypertensives.AdultInitially 50 mg once daily. Maintenance: 25-100 mg once or in 2 divided doses daily.Pregnancy.Facial edema, fever, orthostatic effects, syncope. CV effects. Diarrhea, dyspepsia, anorexia, constipation, dental pain, anemia, gout; muscle cramps, joint pains; CNS disorders; cough, dyspnea, bronchitis, resp congestion; alopecia, dermatitis, urticaria; visual disturbances, taste perversion, tinnitus; impotence, nocturia, UTI.

LOSARTAN + HYDROCHLOROTHIAZIDE (Combizar)Hydrochlorothiazide increases renal excretion of sodium and chloride and reduces cardiac load. Losartan is an angiotensin II receptor (type AT1) antagonist antihypertensive which acts by blocking the actions of angiotensin II of renin-angiotensin-Management of HTN.Per 50/12.5 mg tabLosartan K 50 mg, hydrochlorothiazide 12.5 mg.Per 100/25 mg tabLosartan K 100 mg, hydrochlorothiazide 25 mg

50/12.5-mg1 tab. Max dose:50/12.5-mg2 tab or100/25-mg1 tab. Antihypertensive effect is achieved w/in 3 wk.Hypersensitivity to sulfonamides. Patients w/ anuria & depleted intravascular vol. Pregnancy.Abdominal pain, edema, asthenia, headache; palpitation; diarrhea, nausea; back pain; dizziness; dry cough, sinusitis, bronchitis, pharyngitis, upper resp infection. Rash.

CLONAZEPAM (Rivotril)Clonazepam is an effective anticonvulsant. It raises the threshold for propagation of seizure activity and prevents generalisation of focal or local activity. Clinically, it improves focal epilepsy and generalised seizures. It is also believed to enhance the activity of GABA, and acts as anxiolytic.Epilepsy in infant & childn esp typical & atypical absences, nodding spasms, generalized tonic-clonic seizures. Status epilepticus. Epilepsy of adult & in focal seizures.Initial treatment:Adult & childn >10 yr(>30 kg body wt)1-2 mg/day.Infant & childn 12 yr2 actuations 6 hrly. Max: 12 actuations in 24 hr.Hypertrophic obstructive cardiomyopathy or tachyarrhythmia. Hypersensitivity to soya lecithin or related food products (for MDI).Headache, pain, influenza, chest pain; nausea. Bronchitis, dyspnea, coughing, pneumonia, bronchospasm, pharyngitis, sinusitis, rhinitis.

MONTELUKAST NA + LEVOCETIRIZINE DIHYDROCHLORIDE (Zykast)Montelukast is a selective leukotriene receptor antagonist that blocks the effects of cysteinyl leukotrienes in the airways. Levocetirizine, an active isomer of cetirizine, selectively inhibits histamine H1-receptors.Relief of symptoms associated w/ seasonal & persistent allergic rhinitis.Levocetirizine diHCl 5 mg, montelukast Na 10 mg

Adult & childn >15 yr1 tab daily.Severe renal (CrCl 6 yr1-2 mg/kg/day in divided doses;12 mth-6 yr1-2.5 mg/kg/day in divided doses.Premed before surgeryAdult50-200 mg/day in 1-2 divided doses (single dose 1 hr before surgery, preceded by 1 dose the night before anesth). Max: 200 mg as single dose & 300 mg daily dose.Childn 12 mth1 mg/kg as single dose 1 hr before surgery, preceded by 1 mg/kg the night before anesth.Hypersensitivity to hydroxyzine, cetirizine & other piperazine derivatives, aminophylline or ethylenediamine. Porphyria; preexisting prolonged QT interval. Pregnancy & lactation.Somnolence, headache, fatigue, dry mouth.

LEVODROPROPIZINE (Levopront)Levodropropizine is a cough suppressant that exerts peripheral action in nonproductive cough.Symptomatic treatment of cough.Adult & childn >12 yr10 mL,>2 yr1 mg/kg,20-30 kg5 mL,10-20 kg3 mL. All doses to be taken tid.Patients w/ excessive discharge of mucus, w/ limited mucociliary function, severe liver dysfunction. Pregnancy & lactation. Childn 46 kg body wt20 mg/day,26-45 kg body wt15 mg/day,16-25 kg body wt10 mg/day,2.5 mg/dL in women or end-stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis: 25 mg once daily. May be administered w/o regards to the timing of dialysis. Because there is a dosage adjustment based upon renal function, assessment of renal function is recommended prior to initiation of Januvia & periodically thereafter.Type 1 DM, diabetic ketoacidosis.Hypoglycemia (based on all reports of symptomatic hypoglycemia, concurrent glucose measurement was not required); abdominal pain, nausea, vomiting, diarrhea, dyspepsia, flatulence; hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis & exfoliative skin conditions including Stevens-Johnson syndrome; influenza, headache, acute pancreatitis including fatal & nonfatal hemorrhagic & necrotizing pancreatitis, worsening renal function, upper resp tract infection, fungal skin infection, peripheral edema, nasopharyngitis, constipation, arthralgia, myalgia, pain in extremity, back pain.

METFORMIN Hcl + SITAGLIPTIN (Janumet)The exact mechanism of action of metformin is unclear but it appears to reduce glucose absorption from the GI tract, reduce gluconeogenesis and enhance insulin sensitivity by increasing peripheral glucose uptake and utilisation.Sitagliptin inhibits dipeptidyl peptidase IV (DPP-IV), resulting in prolonged active incretin levels. Incretin hormones increases insulin synthesis and release from pancreatic -cells and reduces glucagon secretion from pancreatic -cells. Reduced glucagon secretion leads to decreased hepatic glucose production.Type 2 DM as initial therapy to improve glycemic control when diet & exercise alone do not provide adequate glycemic control. Type 2 DM as adjunct to diet & exercise to improve glycemic control in patients cannot be controlled w/ metformin or sitagliptin alone or in patients already being treated w/ combination of sitagliptin & metformin. Type 2 DM as an adjunct to diet & exercise to improve glycemic control in combination w/ insulin; sitagliptin & metformin. As part of triple combination therapy w/ a sulfonylurea or w/ a PPAR- agonist (ie thiazolidinediones) as an adjunct to diet & exercise in patients w/ type 2 DM inadequately controlled w/ any 2 of 3 agents: Metformin, sitagliptin or a sulfonylurea alone or a PPAR- agonist alone.Individualized dosing. Initial therapy: Starting dose 50 mg/500 mg bid. May be titrated w/ sitagliptin 50 mg + metformin 1,000 mg bid.Patients inadequately controlled on metformin monotherapySitagliptin 50 mg bid + metformin already taken.Patients inadequately controlled on sitagliptin monotherapy50 mg/500 mg tab bid. May be titrated up to 50 mg/1,000 mg tab bid.Patients switching from sitagliptin co-administered w/ metforminInitiate w/ dose of sitagliptin & metformin already being taken.Patients inadequately controlled on dual combination therapy w/ any 2 of the following 3 antihyperglycemic agents: Sitagliptin, metformin or sulfonylureaSitagliptin 50 mg bid + metformin dose based on glycemic control level. Patients currently on or initiating sulfonylurea may require lower doses of sulfonylurea doses to reduce the risk of sulfonylurea-induced hypoglycemia. Gradual dose escalation to reduce GI effects associated w/ metformin.Patients inadequately controlled on dual combination therapy w/ any 2 of the following 3 antihyperglycemic agents: Sitagliptin, metformin or insulinSitagliptin 50 mg bid + metformin dose based on glycemic control level & current dose (if any) of metformin. Gradual dose escalation to reduce the GI side effects associated w/ metformin should be considered. Patients currently on or initiating insulin therapy may require lower doses of insulin to reduce the risk of hypoglycemia.Patients inadequately controlled on dual combination therapy w/ any 2 of the following 3 antihyperglycemic agents: Sitaglipin, metformin or a PPaR- agonistUsual starting dose of Janumet should provide sitagliptin dosed as 50 mg bid (100 mg total daily dose). In determining the starting dose of the metformin component, the patient's level of glycemic control & current dose (if any) of metformin should be considered.Patients inadequately controlled on dual combination therapy w/ any 2 of the following 3 antihyperglycemic agents: Sitaglipin, metformin or insulinUsual starting dose of Janumet should provide sitagliptin dosed as 50 mg bid (100 mg total daily dose). Patients currently on or initiating insulin therapy may require lower doses of insulin to reduce the risk of hypoglycemia.Renal disease or dysfunction, which may also result from conditions eg CV collapse (shock), acute MI & septicemia. Acute or chronic metabolic acidosis including diabetic ketoacidosis, w/ or w/o coma. Lactic acidosis. Discontinue treatment in patients undergoing radiologic studies. Type 1 diabetes. Pregnancy & lactation.Hypoglycemia, dyspepsia, flatulence, nausea, vomiting, diarrhea, abdominal pain, loss of appetite, metallic taste, upper resp tract infection, headache, cough, fungal skin infection, peripheral edema. Worsening renal function. Constipation. Pancreatitis.