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Heart Failure An association between dipeptidyl peptidase -4 DPP-4 inhibitor treatment and heart failure has been observed in cardiovascular low prices Januvia trials for wendy-summers.com other members of the DPP-4 inhibitor class. These low prices Januvia evaluated patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Consider the risks and benefits of JANUVIA prior to initiating treatment in patients at risk for heart failure, such as those with a prior history of heart failure and a history of renal impairment, and observe these patients for signs and symptoms of heart failure during low price Januvia. Advise patients of the characteristic symptoms of heart failure and to immediately report such symptoms.

A dosage adjustment is recommended in patients with moderate or severe renal low price Januvia and in patients with ESRD requiring hemodialysis or peritoneal dialysis. There have been postmarketing reports of worsening renal function, including low price Januvia renal failure, sometimes requiring low price Januvia. A subset of these reports involved patients with renal insufficiency, some of whom were prescribed inappropriate doses of sitagliptin. A low price Januvia to baseline low prices Januvia of renal insufficiency has been observed with supportive treatment and discontinuation of potentially causative agents. Consideration can be given to cautiously reinitiating JANUVIA if another etiology is deemed likely to have precipitated the acute worsening of renal function.

JANUVIA has not been found to be nephrotoxic in preclinical studies at clinically relevant doses, or in clinical trials. Use With Medications Known To Cause Hypoglycemia When JANUVIA was used in combination with a sulfonylurea or with insulin, medications known to cause hypoglycemia, the incidence of hypoglycemia was increased over that of placebo used in combination with a sulfonylurea or with insulin. 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 JANUVIA, with some reports occurring after the first dose. If a hypersensitivity reaction is suspected, discontinue JANUVIA, assess for other potential causes for the event, and institute alternative treatment for diabetes.

Severe And Disabling Arthralgia There have been postmarketing reports of severe and disabling arthralgia in patients taking DPP-4 inhibitors. Patients experienced relief of symptoms upon discontinuation of the medication.

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