Janecluc (Metformin Hydrochloride, Sitagliptin)

Janecluc, a fixed‑dose combination of metformin and sitagliptin, is indicated for the management of type 2 diabetes mellitus.

• Type 2 diabetes mellitus: improves glycemic control when added to diet, exercise and other antidiabetic agents.
• Inadequate control on metformin alone: provides additional glucose‑lowering effect to achieve target HbA1c.
• Adults requiring combination therapy: simplifies regimen by combining two complementary mechanisms in a single tablet.

• Metformin lowers hepatic glucose production and enhances peripheral insulin sensitivity by activating AMP‑activated protein kinase, while sitagliptin inhibits the enzyme dipeptidyl peptidase‑4, leading to increased endogenous incretin levels (GLP‑1 and GIP). The elevated incretins stimulate glucose‑dependent insulin secretion and suppress glucagon release, together producing a synergistic reduction in blood glucose. This dual action addresses both fasting and post‑prandial hyperglycaemia, offering improved overall glycaemic management.

The combination of metformin and sitagliptin may be associated with several adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: loose stools, often transient.
• Upper respiratory tract infection: symptoms such as sore throat or nasal congestion.
• Headache: mild to moderate intensity.

Serious or Rare Side Effects

• Lactic acidosis: rare but potentially fatal metabolic complication.
• Severe hypoglycaemia: especially when used with insulin or sulfonylureas.
• Pancreatitis: acute inflammation of the pancreas presenting with abdominal pain.
• Anaphylactic reaction: rare systemic allergic response requiring immediate medical attention.

Before prescribing Janecluc, clinicians should consider several precautionary measures to minimise risk and ensure safe use.

• Renal function: assess eGFR and avoid use in severe renal impairment.
• Hepatic function: monitor liver enzymes in patients with existing liver disease.
• Risk of lactic acidosis: discontinue metformin component in conditions predisposing to hypoxia or sepsis.
• Hypoglycaemia: educate patients when combined with insulin or sulfonylureas.
• Pregnancy and lactation: use only if potential benefit justifies potential risk to fetus or infant.
• Store at ambient temperature: keep below 25 °C in original packaging, protect from moisture and direct sunlight.

Janecluc can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Iodinated contrast agents: may precipitate renal dysfunction; hold metformin before and after imaging.
• Insulin or sulfonylureas: increase risk of severe hypoglycaemia.
• Cimetidine: can raise metformin plasma concentrations.

Moderate Interactions (Monitor Closely)

• Diuretics, ACE inhibitors, ARBs: may affect renal function and metformin clearance.
• Beta‑blockers: may mask symptoms of hypoglycaemia.
• Rifampin: may reduce sitagliptin exposure, decreasing glucose‑lowering effect.