sks and benefits of STEGLUJAN and of alternative modes of therapy. Also inform patients about the importance of adherence to dietary instructions, regular physical activity, periodic blood glucose monitoring and HbA1c testing, recognition and management of hypoglycemia and hyperglycemia, and assessment for diabetes complications. Advise patients to seek medical advice promptly during periods of stress such as fever, trauma, infection, or surgery, as medication requirements may change.
Instruct patients to take STEGLUJAN only as prescribed. If a dose is missed, advise patients to take it as soon as it is remembered unless it is almost time for the next dose, in which case patients should skip the missed dose and take the medicine at the next regularly scheduled time. Advise patients not to take two doses of STEGLUJAN at the same time.
Pancreatitis
Inform patients that acute pancreatitis has been reported during use of sitagliptin, a component of STEGLUJAN. Inform patients that persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Instruct patients to promptly discontinue STEGLUJAN and contact their physician if persistent severe abdominal pain occurs [see Warnings and Precautions (5.1)].
Heart Failure
Inform patients of the signs and symptoms of heart failure. Instruct patients to contact their health care provider as soon as possible if they experience symptoms of heart failure, including increasing shortness of breath, rapid increase in weight or swelling of the feet [see Warnings and Precautions (5.7)].
Hypersensitivity Reactions
Inform patients that allergic reactions have been reported during postmarketing use of sitagliptin, a component of STEGLUJAN. If symptoms of allergic reactions (including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing) occur, instruct patients that they must stop taking STEGLUJAN and seek medical advice promptly [see Warnings and Precautions (5.10)].
Severe and Disabling Arthralgia
Inform patients that severe and disabling joint pain may occur with this class of drugs. The time to onset of symptoms can range from one day to years. Instruct patients to seek medical advice if severe joint pain occurs [see Warnings and Precautions (5.12)].
Bullous Pemphigoid
Inform patients that bullous pemphigoid may occur with the DPP-4 class of drugs. Instruct patients to seek medical advice if blisters or erosions occur [see Warnings and Precautions (5.13)].
Hypoglycemia with Concomitant Use of Insulin and Insulin Secretagogue
Inform patients that the incidence of hypoglycemia may increase when STEGLUJAN is added to insulin and/or an insulin secretagogue and that a lower dose of insulin or insulin secretagogue may be required to reduce the risk of hypoglycemia [see Warnings and Precautions (5.8)].
Fetal Toxicity
Advise pregnant patients of the potential risk to a fetus with treatment with STEGLUJAN. Instruct patients to immediately inform their healthcare provider if pregnant or planning to become pregnant [see Use in Specific Populations (8.1)].
Lactation
Advise patients that use of STEGLUJAN is not recommended while breastfeeding [see Use in Specific Populations (8.2)].
Hypotension
