Metformin Hydrochloride + Sitagliptin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. 

Diabetes

• Customise the Metformin Hydrochloride + Sitagliptin starting dose based on the patient's current treatment plan.
• Dosing can be adjusted based on effectiveness and tolerability, as long as the highest recommended daily dose of 100 mg sitagliptin and 2000 mg metformin is not exceeded.
• To reduce the gastrointestinal (GI) side effects of metformin, Metformin Hydrochloride + Sitagliptin should be taken twice daily with meals and gradually increased in dose.

Side effects associated with Metformin Hydrochloride + Sitagliptin include-

• Diarrhea
• Upper respiratory tract infection
• Hypoglycemia
• Headache
• Pharyngitis
• Indigestion
• Asthenia

Diarrhea

URTI (Upper Respiratory Tract Infection)

Hypoglycemia (Low Sugar)

Headache

• Do not use Metformin+Sitagliptin in patients with hepatic disease.
• There have been post-marketing reports of acute renal failure, sometimes requiring dialysis. Before initiating Metformin+Sitagliptin and at least annually thereafter, assess renal function and verify as normal.
• There have been post-marketing reports of acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. If pancreatitis is suspected, promptly discontinue Metformin+Sitagliptin.
• Measure hematologic parameters annually.
• Warn patients against excessive alcohol intake.
• May need to discontinue Metformin+Sitagliptin and temporarily use insulin during periods of stress and decreased intake of fluids and food as may occur with fever, trauma, infection or surgery. 
• Promptly evaluate patients previously controlled on Metformin+Sitagliptin who develop laboratory abnormalities or clinical illness for evidence of ketoacidosis or lactic acidosis.
• When used with an insulin secretagogue (e.g., sulfonylurea) or with insulin, a lower dose of the insulin secretagogue or insulin may be required to reduce the risk of hypoglycemia. 
• There have been postmarketing reports of serious allergic and hypersensitivity reactions in patients treated with sitagliptin (one of the components of Metformin+Sitagliptin), such as anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. In such cases, promptly stop Metformin+Sitagliptin, assess for other potential causes, institute appropriate monitoring and treatment, and initiate alternative treatment for diabetes.
• There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Metformin+Sitagliptin or any other anti-diabetic drug.