Sitagliptin/metformin 50mg/1000mg film-coated tablets

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist, or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Sitagliptin/Metformin is and what it is used for
2. What you need to know before you take Sitagliptin/Metformin
3. How to take Sitagliptin/Metformin
4. Possible side effects
5. How to store Sitagliptin/Metformin
6. Contents of the pack and other information

• if you are allergic to sitagliptin or metformin or any of the other ingredients of this medicine (listed in section 6).
• if you have severely reduced kidney function
• if you have uncontrolled diabetes, with e.g. severe hyperglycaemia (high blood glucose), nausea, vomiting, diarrhoea, rapid weight loss, lactic acidosis (see "Risk of lactic acidosis" below) or ketoacidosis. Ketoacidosis is a condition in which substances called 'ketone bodies' accumulate in the blood and which can lead to diabetic pre-coma. Symptoms include stomach pain, fast and deep breathing, sleepiness or your breath developing an unusual fruity smell.
• if you have severe infection or are dehydrated
• if you are going to have an X-ray where you will be injected with a dye. You will need to stop taking Sitagliptin/Metformin at the time of the X-ray and for 2 or more days after as directed by your doctor, depending on how your kidneys are working
• if you have recently had a heart attack or have severe circulatory problems, such as 'shock' or breathing difficulties
• if you have liver problems
• if you drink alcohol to excess (either every day or only from time to time)
• if you are breast-feeding

Do not take Sitagliptin/Metformin if any of the above apply to you and talk with your doctor about other ways of managing your diabetes. If you are not sure, talk to your doctor, pharmacist or nurse before taking Sitagliptin/Metformin.

Cases of inflammation of the pancreas (pancreatitis) have been reported in patients receiving Sitagliptin/Metformin (see section 4).

If you encounter blistering of the skin, it may be a sign for a condition called bullous pemphigoid.

Your doctor may ask you to stop Sitagliptin/Metformin.

Sitagliptin/Metformin may cause a very rare, but very serious side effect called lactic acidosis, particularly if your kidneys are not working properly. The risk developing lactic acidosis is also increased with uncontrolled diabetes, serious infections, prolonged fasting or alcohol intake, dehydration (see further information below), liver problems and any medical conditions in which a part of the body has a reduced supply of oxygen (such as acute severe heart disease).

If any of the above apply to you, talk to your doctor for further instructions.

Stop taking Sitagliptin/Metformin for a short time if you have a condition that may be associated with dehydration (significant loss of body fluids) such as severe vomiting, diarrhoea, fever, exposure to heat or if you drink less fluid than normal. Talk to your doctor for further instructions.

Stop taking Sitagliptin/Metformin and contact a doctor or the nearest hospital immediately if you experience some of the symptoms of lactic acidosis, as this condition may lead to coma.

Symptoms of lactic acidosis include:

• vomiting
• stomach ache (abdominal pain)
• muscle cramps
• a general feeling of not being well with severe tiredness
• difficulty in breathing
• reduced body temperature and heartbeat

Lactic acidosis is a medical emergency and must be treated in a hospital.

Talk to your doctor or pharmacist before taking Sitagliptin/Metformin:

• if you have or have had a disease of the pancreas (such as pancreatitis)
• if you have or have had gallstones, alcohol dependence or very high levels of triglycerides (a form of fat) in your blood.
  These medical conditions can increase your chance of getting pancreatitis (see section 4)
• if you have type 1 diabetes. This is sometimes called insulin-dependent diabetes
• if you have or have had an allergic reaction to sitagliptin, metformin, or Sitagliptin/Metformin: (see section 4)
• if you are taking a sulphonylurea or insulin, diabetes medicines, together with Sitagliptin/Metformin: as you may experience low blood sugar levels (hypoglycaemia). Your doctor may reduce the dose of your sulphonylurea or insulin.

If you need to have major surgery, you must stop taking Sitagliptin/Metformin during and for some time after the procedure.

Your doctor will decide when you must stop and when to restart your treatment with Sitagliptin/Metformin.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Sitagliptin/Metformin.

During treatment with Sitagliptin/Metformin, your doctor will check your kidney function at least once a year or more frequently if you are elderly and/or if you have worsening kidney function.

Children and adolescents below 18 years should not use this medicine. It is not known if this medicine is safe and effective when used in children and adolescents under 18 years of age.

If you need to have an injection of contrast medium that contains iodine into your bloodstream, for example, in the context of an X-ray or scan, you must stop taking Sitagliptin/Metformin before or at the time of the time of the injection. Your doctor will decide when you must stop and when to restart your treatment with Sitagliptin/Metformin.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. You may need more frequent blood glucose and kidney function tests, or your doctor may need to adjust the dosage of Sitagliptin/Metformin. It is especially important to mention the following:

• medicines (taken by mouth, inhalation, or injection) used to treat diseases that involve inflammation, like asthma and arthritis (corticosteroids)
• medicines which increase urine production (diuretics)
• medicines used to treat pain and inflammation (NSAID and COX-2-inhibitors, such as ibuprofen and celecoxib)
• certain medicines for the treatment of high blood pressure (ACE inhibitors and angiotensin II receptor antagonists)
• specific medicines for the treatment of bronchial asthma (β-sympathomimetics)
• iodinated contrast agents or alcohol-containing medicines
• certain medicines used to treat stomach problems such as cimetidine
• ranolazine, a medicine used to treat angina
• dolutegravir, a medicine used to treat HIV infection
• vandetanib, a medicine used to treat a specific type of thyroid cancer (medullary thyroid cancer)
• digoxin (to treat irregular heartbeat and other heart problems). The level of digoxin in your blood may need to be checked if taking with Sitagliptin/Metformin.

Avoid excessive alcohol intake while taking Sitagliptin/Metformin since this may increase the risk of lactic acidosis (see section "Warnings and precautions").

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. You should not take this medicine during pregnancy or if you are breast-feeding. See section 2, Do not take Sitagliptin/Metformin.

This medicines has no or negligible influence on the ability to drive and use machines. However, dizziness and drowsineshave been reported, which may affect your ability to drive or use machines.

Taking this medicine in combination with medicines called sulphonylureas or with insulin can cause hypoglycaemia, which may affect your ability to drive and use machines or work without safe foothold.

Lactose

Sitagliptin/Metformin HCI 50/850 mg, film-coated tablets contains lactose.

If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medical product.

If you take more than the prescribed dosage of this medicine, contact your doctor immediately. Go to the hospital if you have symptoms of lactic acidosis such as feeling cold or uncomfortable, severe nausea or vomiting, stomach ache, unexplained weight loss, muscular cramps, or rapid breathing (see section "Warnings and precautions").

If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not take a double dose of this medicine.

Continue to take this medicine as long as your doctor prescribes it so you can continue to help control your blood sugar. You should not stop taking this medicine without talking to your doctor first. If you stop taking Sitagliptin/Metformin, your blood sugar may rise again.

If you get any side effects, talk to your doctor, pharmacist, or nurse. This include any possible effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substances are sitagliptin and metformin.
  Sitagliptin/Metformin 50 mg/850 mg film-coated tablets: Each tablet contains 50 mg of sitagliptin (as hydrochloride) and 850 mg of metformin hydrochloride.
  Sitagliptin/Metformin 50 mg/1000 mg film-coated tablets: Each tablet contains 50 mg of sitagliptin (as hydrochloride) and 1000 mg of metformin hydrochloride.
• The other ingredients are:
  Tablet core: Cellulose Microcystalline, Providone (K29/32), Sodium Laurilsulfate and Sodium Stearyl Fumarate
  Film-coating (50 mg/850 mg): Lactose Monohydrate, Hypromellose, Titanium Dioxide, Triacetin & Iron Oxide Red
  Film-coating (50 mg/1000 mg): Polyvinyl alcohol, Macrogol/Polyethylene glycol, Talc, Titanium dioxide, Iron Oxide Red & Black Iron Oxide

Sitagliptin/Metformin 50 mg/850 mg film-coated tablets: Oval-shaped, biconvex, film-coated tablets approximately 20.5 mm x 9.5 mm, pink, debossed with "S476" on one side and plain on the other.

Sitagliptin/Metformin 50 mg/1000 mg film-coated tablets: Oval-shaped, biconvex, film-coated tablets approximately 21.5 mm x 10.0 mm, brown, debossed with "S477" on one side and plain on the other.

Sitagliptin/Metformin 50 mg/850 mg film-coated tablets are package in

• Blisters composed by PVC/PVdC-Aluminium
  14, 28, 30, 56 , 60, 196 and 210
• White HDPE bottle with silica gel desiccant container in the screw-cap
  100

Sitagliptin/Metformin 50 mg/1000 mg film-coated tablets are package in

• Blisters composed by PVC/PVdC-Aluminium
  14, 28, 30, 56 , 60, 196 and 210
• White HDPE bottle with silica gel desiccant container in the screw-cap
  100

Not all pack sized may be marketed.