Glimepiride and pioglitazone is a combination of two oral diabetes medicines that help control blood sugar levels.

Glimepiride and pioglitazone is for people with type 2 diabetes who do not use daily insulin injections. Glimepiride and pioglitazone is sometimes given with other diabetes medications when greater blood sugar control is needed.

This medication is not for treating type 1 diabetes.

Glimepiride and pioglitazone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Duetact (Glimepiride / Pioglitazone)?

You should not use this medication if you are allergic to glimepiride or pioglitazone, if you have severe heart failure, or if you are in a state of diabetic ketoacidosis.

Before taking glimepiride and pioglitazone, tell your doctor if you have congestive heart failure or heart disease, a history of heart attack or stroke, liver disease, or kidney disease.

Taking certain oral diabetes medications may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs. Talk to your doctor about the risks and benefits of treating your diabetes with glimepiride and pioglitazone. Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar.

What should I discuss with my health care provider before taking Duetact (Glimepiride / Pioglitazone)?

You should not use this medication if you are allergic to glimepiride (Amaryl, Avandaryl) or pioglitazone (Actos), or if you have:

• severe heart failure; or
• if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take glimepiride and pioglitazone, tell your doctor if you have:

• congestive heart failure or heart disease;
• a history of heart attack or stroke; or
• liver or kidney disease.

Taking certain oral diabetes medication may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs. Talk to your doctor about the risks and benefits of treating your diabetes with glimepiride and pioglitazone. Some women using glimepiride and pioglitazone have started having menstrual periods, even after not having a period for a long time due to a medical condition. You may be able to get pregnant if your periods restart. Talk with your doctor about the need for birth control. FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Similar diabetes medications have caused severe hypoglycemia in newborn babies whose mothers had used the medication near the time of delivery. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether this medication passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Duetact (Glimepiride / Pioglitazone)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take glimepiride and pioglitazone with your first meal of the day.

Glimepiride and pioglitazone is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your liver function may also need to be tested, and you may need regular eye exams. Do not miss any scheduled visits to your doctor.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking glimepiride and pioglitazone for a short time if any of these situations affect you.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them:

• hunger, headache, confusion, irritability;
• drowsiness, weakness, dizziness, tremors;
• sweating, fast heartbeat;
• seizure (convulsions); or
• fainting, coma (severe hypoglycemia can be fatal).

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

If your blood sugar gets too high (hyperglycemia), you may feel very thirsty or hungry. You may also urinate more than usual. Call your doctor right away if you have any symptoms of hyperglycemia. Store glimepiride and pioglitazone at room temperature, protected from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. A glimepiride overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

Duetact (Glimepiride / Pioglitazone) side effects

Stop using glimepiride and pioglitazone and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• swelling in your feet, rapid weight gain, feeling short of breath (even with mild exertion);
• pale skin, easy bruising or bleeding;
• pain or burning when you urinate; or
• dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
• nausea, vomiting, weakness, loss of appetite, feeling restless or irritable, confusion, hallucinations, muscle pain or weakness, and/or seizure.

Less serious side effects may include:

• sneezing, stuffy nose, cough, sore throat, or other cold symptoms;
• gradual weight gain;
• mild nausea, diarrhea;
• headache, dizziness, blurred vision;
• tooth problems; or
• mild itching or skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Duetact (Glimepiride / Pioglitazone)?

Before taking glimepiride and pioglitazone, tell your doctor if you are taking:

• delavirdine (Rescriptor);
• gemfibrozil (Lopid);
• nicardipine (Cardene) or nifedipine (Adalat, Procardia); or
• rifampin (Rifadin, Rimactane, Rifater); or
• fluconazole (Diflucan), ketoconazole (Nizoral).

Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following:

• albuterol (Proventil, Ventolin);
• clonidine (Catapres);
• reserpine;
• guanethidine (Ismelin); or
• beta-blockers such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.

You may be more likely to have hyperglycemia (high blood sugar) if you are taking glimepiride and pioglitazone with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;
• diuretics (water pills);
• steroids (prednisone and others);
• phenothiazines (Compazine and others);
• thyroid medicine (Synthroid and others);
• birth control pills and other hormones;
• seizure medicines (Dilantin and others); and
• diet pills or medicines to treat asthma, colds or allergies.

You may be more likely to have hypoglycemia (low blood sugar) if you are taking glimepiride and pioglitazone with other drugs that lower blood sugar. Drugs that can lower blood sugar include:

• probenecid (Benemid);
• some nonsteroidal anti-inflammatory drugs (NSAIDs);
• aspirin or other salicylates (including Pepto-Bismol);
• sulfa drugs (Bactrim, Gantanol, Septra, and others); and
• a monoamine oxidase inhibitor (MAOI).

This list is not complete and there may be other drugs that can interact with glimepiride and pioglitazone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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Benfotiamine prevents complications of neuropathy, retinopathy and nephropathy by inhibiting the build-up of glucose in the vessels. This means that the occurrence of diabetic complications might be slowed or prevented.

How to use

As a dietary supplement, take two capsules daily, with or without food.

Drug Class and Mechanism

Benfotiamine is a man-made form of thiamine or B1. Thiamine is a water-soluble vitamin and therefore not as easily used by the body. Benfotiamine is a fat-soluble composition and is better absorbed and utilized. There has been some evidence that benfotiamine may help relieve the severity of diabetic complications such as retinopathy, nephropathy and neuropathy.

Most diabetes complications are caused by prolonged hyperglycemia (high blood sugar) due to poorly controlled blood glucose or to disease progression over time. The excess glucose in the blood is deposited in nerve cells and small blood vessels of the extremities, causing damage in these areas which result in signs and symptoms of complications.

Missed Dose

If you miss a dose of Benfotiamine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Storage

Store Benfotiamine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Benfotiamine out of the reach of children and away from pets.

Warnings/Precautions

You should not use this medication if you are allergic to Saw Palmetto, or have certain conditions. Be sure your doctor knows if you have:

• a bleeding or blood clotting disorder (such as hemophilia);
• stomach ulcer with active bleeding; or
• ulcerative colitis or Crohn’s disease.

Before taking saw palmetto, talk to your doctor, pharmacist, herbalist, or other healthcare provider. You may not be able to use this product if you have:

• liver disease;
• heart disease;
• a heart rhythm disorder;
• a history of stomach ulcer; or
• asthma or other breathing disorder.

Do not take saw palmetto without telling your doctor if you are pregnant or plan to become pregnant during treatment. Saw palmetto may be harmful to an unborn baby. It is not known whether saw palmetto passes into breast milk or if it could harm a nursing baby. Do not use this product without telling your doctor if you are breast-feeding a baby. Do not give any herbal/health supplement to a child without the advice of a doctor.

Possible Side Effects

No side effects attributable to Benfotiamine were observed.

More Information
A clinical study that appeared in the ADA journal Diabetes in 2003 showed that high-dose thiamine and benfotiamine seemed to prevent microalbuminuria and proteinuria (protein in urine) in diabetic rats. Studies done on people have shown that benfotiamine appears to also relieve neuropathic pain.

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Torsemide is a loop diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine.

Torsemide treats fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. This medication is also used to treat high blood pressure (hypertension).

Torsemide may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Demadex (Torsemide)?

Do not use this medication if you are allergic to torsemide or if you are unable to urinate

Before using this medication, tell your doctor if you have kidney disease or liver disease, or an allergy to sulfa drugs..

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

Avoid becoming dehydrated. Follow your doctor’s instructions about the type and amount of liquids you should drink while you are taking torsemide.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

What should I discuss with my healthcare provider before taking Demadex (Torsemide)?

Do not use this medication if you are allergic to torsemide, or if you are unable to urinate.

If you have certain conditions, you may need a dose adjustment or special tests to safely take torsemide. Before using torsemide, tell your doctor if you have:

• kidney disease;
• liver disease; or
• an allergy to sulfa drugs.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether torsemide passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Demadex (Torsemide)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store this medication at room temperature away from heat, light, and moisture. Do not allow the tablets to freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include ringing in your ears, loss of appetite, weakness, dizziness, or confusion.

What are the possible side effects of Demadex (Torsemide)

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using torsemide and call your doctor at once if you have a serious side effect such as:

• dry mouth, thirst, nausea, vomiting;
• feeling weak, drowsy, restless, or light-headed;
• fast or uneven heartbeat;
• muscle pain or weakness;
• coughing up blood;
• bloody or black, tarry stools; or
• hearing loss.

Less serious side effects may include:

• diarrhea or constipation;
• headache;
• dizziness; or
• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Demadex (Torsemide)?

Before taking this medication, tell your doctor if you are using any of the following drugs:

• lithium (Lithobid, Eskalith);
• digoxin (Lanoxin);
• steroids (prednisone and others);
• ethacrynic acid (Edecrin);
• cholestyramine (Prevalite, Questran);
• probenecid (Benemid);
• amikacin (Amikin), gentamicin (Garamycin), netilmicin (Netromycin), streptomycin, tobramycin (Nebcin, Tobi);
• salicylates such as aspirin, Disalcid, Doan’s Pills, Dolobid, Salflex, Tricosal, and others; or
• indomethacin (Indocin).

This list is not complete and there may be other drugs that can interact with torsemide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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Acarbose slows the digestion of carbohydrates in the body, which helps control blood sugar levels.

Acarbose is used to treat type 2 diabetes. Acarbose is sometimes used in combination with insulin or other diabetes medications you take by mouth.

Acarbose may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Precose (Acarbose)?

Do not use this medication if you are allergic to acarbose, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). You also should not use acarbose if you have inflammatory bowel disease, an ulcer or blockage in your intestines, or cirrhosis of the liver.

Before taking acarbose, tell your doctor if you have liver disease, or any type of stomach or intestinal disorder.

Take acarbose with the first bite of a main meal, unless your doctor tells you otherwise.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Do not change your dose or stop taking acarbose without first talking to your doctor.

If you take acarbose with insulin or other diabetes medications, your blood sugar could get too low. Take care to keep your blood sugar from getting too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress. Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, or trouble concentrating. Keep a supply of oral glucose (dextrose) with you in case you have low blood sugar. While you are taking acarbose, candy or table sugar (sucrose) may not work as well as dextrose in quickly raising your blood sugar. Also be sure your family and close friends know how to help you in an emergency.

Acarbose is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

What should I discuss with my healthcare provider before taking Precose (Acarbose)?

Do not use this medication if you are allergic to acarbose, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). You also should not use acarbose if you have:

• inflammatory bowel disease;
• a blockage in your intestines;
• a digestive disorder affecting your intestines;
• intestinal ulcer (of your colon); or
• cirrhosis of the liver.

Before taking acarbose, tell your doctor if you are allergic to any drugs, or if you have:

• liver disease; or
• a bowel or intestinal disorder; or
• a stomach disorder.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether acarbose passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Precose (Acarbose)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take acarbose with the first bite of a main meal, unless your doctor tells you otherwise.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking acarbose for a short time if any of these situations affect you. Do not change your dose or stop taking acarbose without first talking to your doctor.

To be sure this medication is helping your condition, your blood sugar will need to be checked often. Your doctor may also need to do other blood tests on a regular basis. Do not miss any scheduled appointments.

Take care to keep your blood sugar from getting too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them:

• hunger, weakness, nausea, irritability, tremors;
• drowsiness, dizziness, headache, blurred vision;
• confusion, trouble concentrating;
• sweating, fast heartbeat;
• seizure (convulsions); or
• fainting, coma (severe hypoglycemia can be fatal).

Keep a supply of oral glucose (dextrose) with you in case you have low blood sugar. While you are taking acarbose, candy or table sugar (sucrose) may not work as well as dextrose in quickly raising your blood sugar. Also be sure your family and close friends know how to help you in an emergency.

Acarbose is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store acarbose at room temperature in a tightly closed container, away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take it with a meal). If it has been longer than 15 minutes since you started your meal, you may still take acarbose but it may be less effective than taking it with the first bite of the meal. Do not take acarbose between meals, and do not take extra medicine to make up a missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include bloating, gas, or stomach discomfort.

In case of overdose, do not eat or drink anything containing carbohydrates for the next 4 to 6 hours.

Precose (Acarbose) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these liver symptoms:

• low fever;
• nausea, stomach pain, loss of appetite;
• dark urine, clay-colored stools; or
• jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• mild stomach pain, gas, bloating;
• diarrhea; or
• mild skin rash or itching.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Precose (Acarbose)?

You may be more likely to have hyperglycemia (high blood sugar) if you are taking acarbose with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;
• digoxin;
• niacin, nicotine patches or gum;
• diuretics (water pills);
• steroids (prednisone and others);
• phenothiazines (Compazine and others);
• thyroid medicine (Synthroid and others);
• birth control pills and other hormones;
• seizure medications (Dilantin and others);
• cold or asthma medications;
• diet pills, stimulants, or medicines to treat ADHD; or
• a calcium channel blocker such as diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nifedipine (Procardia, Adalat), verapamil (Calan, Covera, Isoptin, Verelan), and others.

This list is not complete and there may be other drugs that can affect your blood sugar or interact with acarbose. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

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Sitagliptin is an oral diabetes medicine that helps control blood sugar levels. It works by regulating the levels of insulin your body produces after eating.

Sitagliptin is for people with type 2 diabetes (non-insulin-dependent) diabetes. Sitagliptin is sometimes used in combination with other diabetes medications, but is not for treating type 1 diabetes.

Sitagliptin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Januvia (Sitagliptin)?

Do not use this medication if you are allergic to sitagliptin or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking sitagliptin, tell your doctor if you have kidney disease or are on dialysis. If you have any of these conditions, you may not be able to use sitagliptin, or you may need a dosage adjustment or special tests during treatment.

You may take this medicine with or without food. Follow your doctor’s instructions.

Follow your doctor’s instructions about any restrictions on food, beverages, or activity while you are taking sitagliptin.

Sitagliptin is only part of a complete program of treatment that also includes diet, exercise, weight control, and possibly other medications. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

What should I discuss with my healthcare provider before taking Januvia (Sitagliptin)?

Do not use this medication if you are allergic to sitagliptin, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking sitagliptin, tell your doctor if you have kidney disease or if you are on dialysis. If you have any of these conditions, you may not be able to use sitagliptin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Your name may need to be listed on a sitagliptin pregnancy registry when you start using this medication.

It is not known whether sitagliptin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Sitagliptin should not be given to a child younger than 18 years old without a doctor’s advice.

How should I take Januvia (Sitagliptin)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger or smaller amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

You may take this medicine with or without food. Follow your doctor’s instructions.

Sitagliptin is only part of a complete program of treatment that also includes diet, exercise, weight control, and possibly other medications. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking sitagliptin for a short time if any of these situations affect you.

Store sitagliptin at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food if your doctor has instructed you to). If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. You may have signs of low blood sugar, such as hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma.

Januvia (Sitagliptin) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have fever, sore throat, and headache with a severe blistering, peeling, and red skin rash. These could be signs of a serious side effect.

Less serious side effects may include:

• runny or stuffy nose, sore throat;
• headache; or
• nausea, stomach pain, diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Januvia (Sitagliptin)?

Before you take sitagliptin, tell your doctor if you are also taking digoxin (Lanoxicaps, Lanoxin). You may not be able to take sitagliptin, or you may require a dosage adjustment or special monitoring.

Although sitagliptin is not as likely to cause hypoglycemia (low blood sugar) as some other oral diabetes medications, tell your doctor if you are taking any other drugs that can potentially lower blood sugar, such as:

• probenecid (Benemid);
• nonsteroidal anti-inflammatory drugs (NSAIDs);
• aspirin or other salicylates (including Pepto-Bismol);
• sulfa drugs (Bactrim and others);
• a monoamine oxidase inhibitor (MAOI); or
• beta-blockers (Tenormin and others).

This list is not complete and there may be other drugs that can interact with sitagliptin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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Vein Support contains DiosVei, a form of the flavonoid diosmin, which has been used for over thirty years as a vascular-supportive agent in Europe.

How Taken

Take one capsule two times daily. For optimal absorption, take with a fat-containing meal or snack.

Drug Class and Mechanism

DiosVein is derived from sweet orange and is a rich source of bioflavonoids. Clinical studies conducted in Europe have shown DiosVein to be particularly effective at supporting the health of blood vessels and promoting normal circulatory function. Further clinical trials have found that diosmin used in combination with the flavonoid hesperidin supports healthy venous function.

Diosmin has numerous beneficial effects on blood vessels and circulation. These effects include enhancing venous tone, supporting lymphatic drainage, promoting the health of cells comprising the blood vessel lining and supporting normal, but not excessive, capillary permeability. Flavonoids in general may support vessel health by preventing the abnormal synthesis of prostaglandins and related mediators, or by blocking the adverse effects of these substances on venous tissue.

Vein Support also features natural vitamin K2, a form of K2 found in the traditional Japanese fermented food, natto. Recent studies highlight the importance of adequate vitamin K2 levels for healthy blood vessel function. It is a long-acting form of vitamin K2that has been shown to support cardiovascular health.

The major role for vitamin K2 seems to be its ability to activate a protein present in blood vessels known as Matrix Gla Protein (MGP). MGP is thought to be responsible for venous remodeling and is known to act as an inhibitor of vessel calcification as shown in mice studies. Further studies in rats show that administration of substances that antagonize (or oppose) the normal effects of vitamin K2, and thus inhibit the proper activation of MGP, also significantly and rapidly leads to vessel calcification.

Missed Dose

If you miss a dose of Vein Support, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Storage

Store Vein Support at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Vein Support out of the reach of children and away from pets.

Warnings/Precautions

Himplasia should be used with caution in patients with hypertension.

Possible Side Effects

Vein Support is not known to have any side effects if taken as per the prescribed dosage.

More Information

Two smaller studies conducted as double-blind placebo-controlled investigations assessed the impact of 500 mg of the flavonoid combination (consisting of diosmin and hesperidin) taken daily on enhancement of venous function (Ramelet 2005). In the first study, 40 participants with compromised venous function were divided into a treatment and placebo arm. Global improvement scores were calculated for various clinical parameters of venous health. The participants in the treatment group supplementing with 500 mg of the combination showed significantly greater enhancements in venous function after two months of therapy compared to participants in the placebo group. A second double blind, placebo-controlled investigation conducted in 160 individuals also showed beneficial effects. In this study, individuals were divided into a placebo group and a treatment group supplementing with 500 mg of the flavonoid combination twice daily (1000 mg total per day) for eight weeks. Evaluation of change in venous parameters was the endpoint of this study. The results of this investigation concluded that individuals taking the flavonoid supplement had significant improvements in venous health when compared with the participants in the placebo arm of the study. Both studies confirmed the beneficial influences of these flavonoids on endothelial health and venous function.

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Miglitol delays the digestion of carbohydrates (forms of sugar) in your body. This decreases the amount of sugar that passes into your blood after a meal and prevents periods of hyperglycemia (high blood sugar).

Miglitol is used to treat non-insulin-dependent (Type II) diabetes mellitus.

Miglitol may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Glyset (Miglitol)?

Take each dose of miglitol with the first bite of a main meal.

Know the signs and symptoms of low blood sugar, which include headache, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremor, and, nausea. Carry glucose tablets, paste, or another glucose or dextrose substance to treat episodes of low blood sugar.

Who should not take Glyset (Miglitol)?

Before taking this medication, tell your doctor if you have

• an inflammatory bowel disease, such as ulcerative colitis or Chron’s disease; or any other disease of the stomach or intestines;
• ulcers of the colon;
• a blockage or obstruction in your intestines; or
• kidney disease.

You may not be able to take miglitol, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Call your doctor if you develop a fever or an infection, or if you experience a serious injury. You may require insulin for a period of time to control your blood sugar levels.

Miglitol is in the FDA pregnancy category B. This means that it is not expected to harm an unborn baby. Do not take miglitol without first talking to your doctor if you are pregnant. Miglitol passes into breast milk and may affect a nursing infant. Do not take miglitol without first talking to your doctor if you are breast-feeding a baby.

How should I take Glyset (Miglitol)?

Take miglitol exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take each dose with the first bite of a main meal. Store miglitol at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

An overdose of this medication is unlikely to occur. Symptoms of an overdose are unknown, but stomach pain, gas, bloating, and diarrhea might be expected.

Glyset (Miglitol) side effects

Stop taking miglitol and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).

Other, less serious side effects, are more likely to occur. Continue to take miglitol and talk to your doctor if you experience

• abdominal pain,
• diarrhea,
• flatulence, or
• a rash.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Glyset (Miglitol)?

Digestive-enzyme supplements such as pancreatin (amylase, protease, lipase) in products such as Arco-Lase, Cotazym, Donnazyme, Pancrease, Creon, Ku-Zyme, and others may decrease the effects of miglitol. These medications should not be taken at the same time as miglitol.

Before taking this medication, tell your doctor if you are taking any of the following medicines:

• propranolol (Inderal);
• ranitidine (Zantac, Zantac 75);
• digoxin (Lanoxin, Lanoxicaps),
• another diabetes medicine such as glyburide (Micronase, Diabeta, Glynase), glipizide (Glucotrol), tolbutamide (Orinase), metformin (Glucophage), and others;
• a thiazide diuretic (water pill) such as hydrochlorothiazide (HCTZ, Hydrodiuril, others), chlorothiazide (Diuril), chlorthalidone (Thalitone), indapamide (Lozol), and others;
• a steroid medication such as prednisone (Deltasone), methylprednisolone (Medrol), and others;
• an estrogen (Premarin, Ogen, and others) or an estrogen-containing birth control pill;
• a thyroid medication (Synthroid, Levoxyl, and others);
• phenytoin (Dilantin); or
• a calcium channel blocker such as verapamil (Calan, Verelan, Isoptin), diltiazem (Cardizem, Dilacor XR), nifedipine (Procardia, Adalat), and others.

The drugs listed above may interact with miglitol or affect blood sugar levels. You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with miglitol or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

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Amaryl (Glimepiride)

Glimepiride is an oral diabetes medicine that helps control blood sugar levels. This medication helps your body respond better to insulin produced by your pancreas.

Glimepiride is used together with diet and exercise to treat type 2 (non-insulin dependent) diabetes. Insulin or other diabetes medicines are sometimes used in combination with glimepiride if needed.

Glimepiride may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Amaryl (Glimepiride)?

Do not use this medication if you are allergic to glimepiride, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Take care not to let your blood sugar get too low, which can be caused by stress, skipping a meal, exercising too long, or drinking alcohol.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them. Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. Severe hypoglycemia may cause loss of consciousness, seizures, or death. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection. If your blood sugar gets too high (hyperglycemia), you may feel very thirsty or hungry. You may also urinate more than usual. Call your doctor right away if you have any symptoms of hyperglycemia.

Glimepiride is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

What should I discuss with my doctor before taking Amaryl (Glimepiride)?

You should not use this medication if you are allergic to glimepiride, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take glimepiride, tell your doctor if you have:

• heart disease;
• liver or kidney disease;
• an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD);
• adrenal or pituitary gland problems; or
• if you are under-nourished.

FDA pregnancy category C. It is not known whether glimepiride is harmful to an unborn baby. Before using glimepiride, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether glimepiride passes into breast milk or if it could be harmful to a nursing baby. Do not take glimepiride without telling your doctor if you are breast-feeding a baby.

How should I take Amaryl (Glimepiride)?

Take glimepiride exactly as it was prescribed for you. Do not take the medication in larger or smaller amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your dose needs may change if you are ill, if you have a fever or infection, or if you have surgery or a medical emergency.

Do not change your dose of glimepiride without first talking to your doctor. Glimepiride is usually taken once a day with breakfast or the first main meal of the day. Follow your doctor’s instructions. Take glimepiride with a full glass of water.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them. Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. Severe hypoglycemia may cause loss of consciousness, seizures, or death. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

To be sure this medication is helping your condition, you will need to check your blood sugar at home. Your blood will also need to be tested by your doctor on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Glimepiride is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

It is important to take glimepiride regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store glimepiride at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. A glimepiride overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, seizure (convulsions), and coma.

Amaryl (Glimepiride) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• severe skin rash, itching, redness, or irritation;
• pale skin, easy bruising or bleeding, fever, unusual weakness;
• dark urine, clay-colored stools;
• upper stomach pain, low fever, jaundice (yellowing of the skin or eyes); or
• nausea, vomiting, loss of appetite, feeling restless or irritable, confusion, hallucinations, muscle pain or weakness, and/or seizure.

Less serious side effects may include:

• dizziness, headache, tired feeling;
• mild nausea, vomiting, stomach pain, diarrhea;
• increased skin sensitivity to sunlight; or
• mild itching or skin rash.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them. Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. Severe hypoglycemia may cause loss of consciousness, seizures, or death. If you have severe hypoglycemia and cannot eat or drink, give an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection. If your blood sugar gets too high (hyperglycemia), you may feel very thirsty or hungry. You may also urinate more than usual. Call your doctor right away if you have any symptoms of hyperglycemia.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Amaryl (Glimepiride)?

Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following:

• albuterol (Proventil, Ventolin);
• clonidine (Catapres);
• reserpine;
• guanethidine (Ismelin); or
• a beta-blocker such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.

You may be more likely to have hypoglycemia (low blood sugar) if you are taking glimepiride other drugs that lower blood sugar. Drugs that can lower blood sugar include:

• clarithromycin (Biaxin);
• probenecid (Benemid);
• some nonsteroidal anti-inflammatory drugs (NSAIDs);
• aspirin or other salicylates (including Pepto-Bismol);
• a blood thinner (warfarin, Coumadin and others);
• a monoamine oxidase inhibitor (MAOI); and
• sulfa drugs (Bactrim, Gantanol, Septra, and others).

You may be more likely to have hyperglycemia (high blood sugar) if you are taking glimepiride with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;
• diuretics (water pills);
• steroids (prednisone and others);
• phenothiazines (Compazine and others);
• thyroid medicine (Synthroid and others);
• birth control pills and other hormones;
• seizure medicines (Dilantin and others);
• diet pills; and
• medicines to treat asthma, colds or allergies.

These lists are not complete and there are many other medicines that can increase or decrease the effects of glimepiride on lowering your blood sugar. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

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It maintains proper blood sugar balance, a very important component of maintaining good health. It also helps regulate lipid metabolism and maintain healthy serum triglyceride and cholesterol levels. Diabecon’s benefits have been linked to an improved regeneration of pancreatic cells.

How Taken

Take 2 tablets twice daily, 30 minutes before meals on an empty stomach. If needed, may increase to 2 tablets three times daily.

Drug Class and Mechanism

Diabecon increases the peripheral utilization of glucose. Diabecon increases the hepatic and muscle glycogen content. Diabecon promotes b-cell repair/regeneration and increases the C-peptide level. As it has antioxidant properties, Diabecon exerts an insulin-like action. By reducing the glycated hemoglobin level, normalizing the microalbuminuria and modulating the lipid profile, Diabecon minimizes the long term diabetic complications.

Missed Dose

If you miss a dose of this medicine and you are using it regularly, take it as soon as possible. Do not take 2 doses at once.

Storage

Store at the room temperature away from moisture and sunlight. Keep out of the reach of children.

Warnings/Precautions

Himplasia should be used with caution in patients with hypertension.

Possible Side Effects

Diabecon is not known to have any side effects if taken as per the prescribed dosage.

More Information

By reducing the glycated hemoglobin level, normalizing the microalbuminuria and modulating the lipid profile, Diabecon minimizes the long-term diabetic complications.

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Karela is known to aid in the metabolism of carbohydrates.

How Taken

One or two caps twice daily. To be swallowed with water or milk.

Drug Class and Mechanism

Throughout history, the extracts of Karela have been used in natural medicine of their purifying qualities. Karela is a blood purifier, activates spleen and liver and is highly beneficial in diabetes. It is a purgative, appetizer, digestive, anti inflammatory, anti flatulent and has healing capacity.

Missed Dose

If you miss a dose of this medicine and you are using it regularly, take it as soon as possible. Do not take 2 doses at once.

Storage

Store at the room temperature away from moisture and sunlight. Keep out of the reach of children.

Warnings/Precautions

Himplasia should be used with caution in patients with hypertension.

Possible Side Effects

Karela is not known to have any side effects if taken as per the prescribed dosage.

More Information

Investigations were carried out to evaluate the effect of Momordica charantia (Karela) on the glucose tolerance of maturity onset diabetic patients. The juice of Momordia charantia (Karela) was found to significantly improve the glucose tolerance of 73% of the patients investigated while the other 27% failed to respond.

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