How are braces different from aligners?

Of course, aligners are a new word in teeth alignment. Unlike braces, aligners are removable and wash well with a brush and paste. They and do not complicate daily oral hygiene and do not have a significant effect on tooth enamel. Braces, on the other hand, require more complex daily hygiene, as they themselves contribute to the formation of plaque in places that are difficult to clean.

The transparent bite correction plate does not put painful pressure on the teeth. Adaptation to it takes place quickly, and the movement of teeth to the planned position is gradual.

When wearing aligners, the number of visits to the dentist is reduced to once every 2-3 months. While bite correction on braces requires a visit to the orthodontist’s office once every 1-1.5 months.

A big advantage is that transparent orthodontics has a predictable treatment outcome. Preliminary scanning of the oral cavity and computer 3D modeling of the treatment plan allow you to see how the position of the teeth will change during the treatment.

Aligners or braces – which is better? Both are tools in the hands of an orthodontist. Each has its pros and cons.

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Couperosis and dilated veins on the face: what can and cannot be done?

First, let’s look at the types of veins that can occur on the face and The most common include:

Dilated veins of the paraorbital region: veins around the eyes (often located at the lower and outer edges of the eye), temporal veins (formed in the temple area, sometimes capturing the frontal part of the face, and then the scalp). Most often, the diameter of such veins is from 0.5 mm to 4 mm.
Separate single vessels, telangiectasias – small veins less than 1 mm in diameter of blue, purple and pink, localized in the face, wings of the nose, above the upper lip, chin.
Couperose is an accumulation of dilated vascular networks in the cheeks, cheekbones, less often in other areas – the neck, décolleté, etc.

The first two variants of veins (paraorbital, temporal, separate telangiectasias) in most cases are only an aesthetic feature, not associated with any significant pathology. The patient is allowed to play sports, fly an airplane, sunbathe and swim. Even if a trip to the south provokes a couple of new vessels, the situation will still not be critical. With such veins, you can live a normal life without binding yourself to any noticeable restrictions.

The paraorbital and temporal veins may increase in size during intense exercise. This phenomenon is a consequence of increased blood flow. After training, it completely disappears, the veins return to their previous size.

As for rosacea, it is important to understand the cause of the appearance of pronounced vessels on the face. For example, exposure to temperature factors (cold or heat) can aggravate the situation. Therefore, long snowboarding and skiing, frequent trips to the sauna, solarium and prolonged insolation should be limited. The same applies to alcohol, nicotine – they affect vascular tone, which also manifests itself on the face.

The answer to the question “is it possible to play sports with rosacea” will also be positive. In moderate amounts (not in hot or frosty weather), physical activity gives only a short-term rush of blood and a temporary increase in the vascular pattern on the face. Accordingly, after playing sports, everything becomes as before.

The choice of cosmetic procedures for this pathology also has its own characteristics. For example, peeling with rosacea is allowed, mainly superficial (enzymatic). Cream for rosacea is recommended to be selected together with a cosmetologist. It is also important to remember that any active massage for rosacea is not indicated, as it can provoke deterioration.

If the appearance of blood vessels on the face is caused by some serious disease (for example, systemic lupus erythematosus, SLE), then the restrictions become already stricter. Patients should avoid prolonged exposure to the sun (possible photosensitivity). The sports program must be coordinated with the attending physician – a rheumatologist, cardiologist or other specialized specialist.

SLE can affect various organs and systems, therefore, the limiting factors for sports are no longer blood vessels on the face, but pathologies of the joints, heart, etc. More detailed information about all restrictions can be obtained after a thorough history taking at an in-person consultation with a doctor.

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MAR test

One of the most often tricky questions at a reception. What is it? I decided to add a fresh sip of smart science to the content. Well, how is it science? So, dry medical calculations in simple, human language.

Friends often tell me, they say, keep it simple and avoid burnout. They don’t believe that I have balls of steel and Well, okay …

In our body there is such a nice immunity, designed to protect us from any intervention from the outside, which, for some reason, according to the majority of educated people, needs to be constantly supported, fenced off and protected We need to protect immunity so that it would protect us … Hmm ..Such a recursion.
To put it simply, he does it by recognizing “friend or foe” and if he does not recognize his own, he attacks godlessly. By means of all sorts of t-killers, these are lymphocytes … Well, not the point.

And also, this cunning immunity produces special large proteins – immunoglobulins, which stick around all evil spirits and do not allow this muck to do its heinous business – to bring you death.

Recently I had the dubious happiness to talk to d-doctors and listen to a lot of derambs about omegas, vitamins, and other antioxidants. So, I almost believed that fish oil (omega) somehow mythically raises and strengthens the immune system.

I have been trying for a long time to find out with what such strong witchcraft this very fat teaches natural killers to recognize someone else’s, i.e. to plant specific receptors on immune cells, but did not receive a clear response, because only a malicious alien antigen can do this. And I realized that I just need to repent to me, the wicked, and believe in this cosmic heresy. Along the way, however, it is also necessary to support the liver by removing toxins. Where to? Apparently, right in Moscow.

It was a lyrical digression, if cho.
You will be surprised, but our immunity does not see spermatozoa! Male testicles have a kind of barrier that protects sperm from their own immunity.
Can you imagine? But sometimes, for some reason, this barrier is violated (injuries, infections, even hell knows what HEH) and the immune system, seeing sperm, thinks that the body was attacked by foreign cells. Here it would be just right to suppress it, but we are strengthening it!
Having fallenomorphized a little from such a meeting, the immune system begins to synthesize specific immunoglobulins that stick around the sperm and deprive them of their romantic oh! dating a female egg! So, the MAR test shows how much (in percentage) the sperm are carried by these same proteins. Zhivik can be quite fast, active, but because of the load on himself, he cannot fertilize an egg. Normally, up to 40% of these can be in the ejaculate. Less is more, though. The increased MAR test is extremely difficult to treat, therefore it is a direct indication for IVF.

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Convulsions are involuntary muscle contractions of an attack-like nature

Almost everyone has experienced a single cramp at least once in their life. Most often it is a sudden painful contraction (spasm) of muscles lasting from a few seconds to several minutes.
In most cases, a single episode of cramps passes without consequences or special treatment. But if these episodes recur frequently, it is necessary to go to the doctor, as it may indicate the presence of serious health problems.
The most common cramps are of the calves and thighs, as well as the muscles of the feet and hands. Seizures of facial muscles, neck, larynx, respiratory muscles are also quite common (convulsive activity in them leads to stuttering). This drug helps against some types of seizures:

Varieties of seizures

woman massaging her leg on white bed

There are several varieties of seizures, classifying them according to different characteristics.

By nature:

Tonic – strong muscular tension, forcing to “freeze” in an unnatural posture;
Clonic – rhythmic twitching of a muscle/muscle. Various tics, as well as stuttering (convulsions of respiratory muscles, larynx) belong exactly to the clonic type;
Tonic-clonic and clonic-tonic – are characteristic of epilepsy, when during a seizure, the tonic and clonic phases alternate with each other.
By prevalence:

Local (focal) seizures – contraction of individual muscles or groups of muscles;
Generalized convulsions – the contractile activity covers several muscle groups.
According to the mechanism of development:

Convulsive reaction occurs in response to micronutrient deficiencies, infection, insufficient blood supply, intoxication, being in a stuffy room, etc;
seizure syndrome develops, as a rule, in diseases of the nervous system, which help to identify the study of electrical activity of the brain;
epilepsy is a disease characterized by recurrent, often generalized (covering the entire body) convulsive seizures.
Possible causes of seizures

Muscle cramps can result from a variety of conditions, such as:

Excessive intake of alcohol, medications (diuretics, antidepressants, etc.), caffeine, nicotine;
An increase in body temperature above 38.5 ° C – the so-called subfebrile seizures, are common mainly in young children (under four years);
Brain tumors and other changes in brain structure;
deterioration of cerebral circulation, craniocerebral injuries;
Increased blood pressure and blood glucose levels;
acute dehydration of the body;
disorder of water-salt metabolism, deficiency of microelements;
Severe fatigue, lack of sleep, prolonged psychological stress;
Excessive physical activity or muscle strain;
nerve entrapment;
overcooling or overheating;
anemia (decreased concentration of hemoglobin in the blood);
genetic predisposition to increased seizure activity.

In what diseases seizures occur

Most (up to 90%) of seizures occur once and remain in memory as an unpleasant incident. But if they occur over and over again – most likely in this way the body signals about some serious disorders. Harmless blepharospasm (eyelid trembling) may indicate the development of a dangerous syndrome of “dry eye” or even glaucoma (increase in intraocular pressure). Clonic hand cramps could indicate the development of Parkinson’s disease, etc.
Detecting these problems as early as possible and starting timely treatment means prolonging the period of active life, preventing the reduction of its quality and disability.
Seizures of the same form may occur with various diseases of the nervous system, such as meningitis, encephalitis, brain tumors, aneurysms (bulging of the wall) of the brain vessels, intracerebral hemorrhages, etc. Seizures are also often an early symptom of hereditary degenerative diseases of the nervous system, as well as progressive senile dementias.

Seizures often accompany diseases of the cardiovascular system, autoimmune diseases such as systemic lupus erythematosus, rheumatism, etc.
Seizures caused by impaired brain function develop in hypo- and hyperglycemic, as well as in hepatic coma.
Convulsions in young children, not associated with an increase in body temperature, may be a symptom of brain and cardiovascular system malformations, hereditary diseases.

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What is Depon?

Depon (Depon) is a pain reliever and a fever reducer. The exact mechanism of Depon of is not known.

Depon is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint.

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


An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, Depon or Depon is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of Depon.

For systemic use of Depon Sante Naturelle: prevention and treatment of hypo- and avitaminosis of vitamin C; providing increased need for vitamin C during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in winter with an increased risk of infectious diseases.

For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal microflora.


Use Depon exactly as directed on the label, or as prescribed by your doctor.

Do not use more of this medication than is recommended. An overdose of Depon can cause serious harm. The maximum amount for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Using more Depon could cause damage to your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking Depon and never use more than 2 grams (2000 mg) per day. If you are treating a child, use a pediatric form of Depon. Carefully follow the dosing directions on the medicine label. Do not give the medication to a child younger than 2 years old without the advice of a doctor.

Measure the liquid form of Depon with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. You may need to shake the liquid before each use. Follow the directions on the medicine label.

The Depon chewable tablet must be chewed thoroughly before you swallow it.

Make sure your hands are dry when handling the Depon disintegrating tablet. Place the tablet on your tongue. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

To use the Depon effervescent granules, dissolve one packet of the granules in at least 4 ounces of water. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Depon (Depon) is a pain reliever and a fever reducer
Depon (Depon) is a pain reliever and a fever reducer

Do not take a Depon rectal suppository by mouth. It is for use only in your rectum. Wash your hands before and after inserting the suppository.

Try to empty your bowel and bladder just before using the Depon suppository. Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

For best results from the suppository, lie down and insert the suppository pointed tip first into the rectum. Hold in the suppository for a few minutes. It will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the bathroom just after inserting the suppository.

Stop using Depon and call your doctor if:

  • you still have a fever after 3 days of use;
  • you still have pain after 7 days of use (or 5 days if treating a child);
  • you have a skin rash, ongoing headache, or any redness or swelling; or
  • if your symptoms get worse, or if you have any new symptoms.

Urine glucose tests may produce false results while you are taking Depon. Talk to your doctor if you are diabetic and you notice changes in your glucose levels during treatment.

Store Depon at room temperature away from heat and moisture. The rectal suppositories can be stored at room temperature or in the refrigerator.


There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

If the condition of your stomach no longer bothers you, then you can safely go to work, and you will find the best vacancies on this site –

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Vladimir Stefanov about right choice

Vladimir Stefanov is not just a doctor with a higher education as a surgeon.
Vladimir Stefanov is not just a doctor with a higher education as a surgeon.

In the last 10 years, plastic surgery to correct the breast and the anterior abdominal wall has become very popular in russia.  Although we have not yet come close to the number of such operations that is performed in developed countries.  And the point is not that these operations are paid – they are not so expensive that our women cannot afford them.  But we tend to be afraid of plastic surgery.  And, unfortunately, not by chance.  In the west, cases of serious complications are extremely rare, all manipulations are carried out only in well-equipped centers, if each surgeon, each clinic has a huge number of permits and licenses. 

There, as a rule, young, inexperienced doctors start their careers, who take on literally everything without the necessary skills.  Patients who buy into bright advertisements or the proximity of such an institution to their homes believe that they have saved time and money.  But there are much more contraindications for plastic surgery than even in conventional surgery!

Vladimir Stefanov is not just a doctor with a higher education as a surgeon.
Vladimir Stefanov is not just a doctor with a higher education as a surgeon.

You must first conduct the most thorough examination.  You can only trust large centers with a good intensive care unit.  Both operations are large in volume, long-term (they work on the breast up to 4.5 hours, the stomach can be done in 2.5-3 hours).  Abdominoplasty can be performed under epidural anesthesia or, like breast surgery, under general anesthesia.  In any case, the most qualified anesthesiologist is needed.

Vladimir Stefanov think after the operation, the patient is placed in intensive

After the operation, the patient is placed in intensive care for a couple of hours, then in the ward for 1-2 days, and only then is discharged from the hospital.  After plastic surgery of the anterior abdominal wall, a sparing regimen is prescribed for three months, you can not lift weights, strain, play sports.

Unfortunately, after surgical interventions, a trace cannot but remain.  Of course, the scars after plastic surgery are neat, unobtrusive, but they are still there.  Also, complications are possible after any operation.  One famous doctor said at the congress: “if a surgeon says he works without complications, he either practices little or has a short memory.”  it’s another matter that complications are rare in the work of an experienced doctor, and most importantly, he knows how to cope with them.

Vladimir Stefanov is not just a doctor with a higher education as a surgeon.
Vladimir Stefanov is not just a doctor with a higher education as a surgeon.

Vladimir Stefanov is not just a doctor with a higher education as a surgeon, but a real outstanding person who performs all operations without a drop of doubt.  He does everything qualitatively that patients cannot find a scar or suture after healing.  After this, happy patients ask him questions: “did you really operate on me?  Otherwise i can’t understand where.

Vladimir Stefanov think, that result of the work of a plastic surgeon is always noticeable: everything is outside, in plain sight. 

And the patient (all the more so – the patient!) Meticulously examines each shovchik under a magnifying glass, examines himself for hours in the mirror.  Of course, before the operation, the doctor explains that the final result will be in 3 months – swelling and bruising should disappear … But, as a rule, the morning after removing the bandage begins with the patient’s impatient cry: “doctor, will it really stay like this ?!  “.  Of course not!  Everything will be beautiful, the main thing is to choose a good specialist.

“tummy tuck” (as patients most often call it) is not an operation to treat obesity and reduce weight.  Its essence is to remove the so-called skin and fat “apron”.  It is formed, firstly, after pregnancy and childbirth (one or more): the skin of the abdomen sags, the muscles stretch and sometimes even diverge.  Unfortunately, no one knows in advance if such a nuisance can happen to him after the birth of the baby. 

Vladimir Stefanov is not just a doctor with a higher education as a surgeon.
Vladimir Stefanov is not just a doctor with a higher education as a surgeon.

To a small extent, the age of the mother and the size of the fetus, the use or non-use of bandages during pregnancy may matter.  But still, the figure and weight are not so important, and whether a woman went in for sports, whether she ate right – hereditary, congenital factors are important.  Stretch marks and even more so “apron” will not be if the skin is naturally elastic.  Then the stomach will tighten, and everything will fall into place in the literal and figurative sense. The second category of people in need of abdominoplasty are those who have managed to lose a lot of weight through diet or special medical procedures.  Yes, people sometimes lose weight by 40 or even 70 kg – there is no fat, but the “apron” can hang almost to the middle of the thighs.

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A good medical laboratory: how to define it?

How to choose the right laboratory and who can you trust with your analyzes? Let’s start with a banal advice – if you are not self-medicating, then first of all listen to the opinion of your doctor, it is he who will advise you on the right laboratory, since many patients pass through it with analyzes from different manufacturers. The doctor most often has an idea in which laboratories the analyzes agree with the clinical picture, and which ones are godlessly wrong.

If we talk about serious private companies that are engaged in laboratory diagnostics in Russia, then all of them are quite highly automated, and therefore 90% of errors occur at the preanalytical stage (from the moment the patient prepares for testing to their entry into the analyzer). In this regard, the advice – network laboratories with hundreds of branches from Moscow to Krasnoyarsk are not the best choice, all of them are equipped with automatic tube sorting stations. Since the biomaterial arrives from very remote places and sometimes even takes more than 48 hours to reach the laboratory, and a significant proportion of analyzes must be delivered to the analyzer within 12 hours after taking, the criteria for rejection of samples are deliberately underestimated. Thus, some of the results are not entirely reliable, which is confirmed by negative reviews on the Internet. In addition, sorters work more rudely than people, and therefore the share of rejection of test tubes “according to formal” criteria is high. those where the barcode is crookedly glued or the shade of the cover is slightly different from the base one, which leads to re-digging. Also, “laboratory factories” completely abandon medical validation, that is, the doctor’s review of the analyzer’s result before issuing it to the patient, at the time of searching for contradictions between various tests or the clinical picture.

A good medical laboratory: how to define it?

A very important sign of quality laboratory work is participation in external quality assessment (EQA) programs. How do these programs work? The world’s largest manufacturers of reagents prepare standardized sera and send them to partner laboratories around the world, where doctors measure them on their equipment, and enter the data into electronic forms, if they are correct from month to month, at the end of the research cycle (usually 12 months) laboratory receives a certificate. “Gold Standard” – EQAS EQAS program from Biorad company, participating laboratories post certificates on their websites. Please note that certificates must be renewed annually.

The next advice follows from the previous one, we do not recommend taking tests in medical centers that have their own laboratories or laboratories of municipal and departmental clinics, EQA programs cost decent money. It is unprofitable for medical centers with less than a hundred samples per day, and the state does not allocate money for EQA to municipalities.

A good medical laboratory: how to define it?

Another reason why, as a rule, the quality of analyzes in state institutions is lower – lower salaries of staff, and as a result, lower qualifications, and in the regions it is often also the inability to work on reagents that are “native” for analyzers.

Choosing a laboratory is not easy, and it is necessary to treat this process in the same way as the process of choosing a doctor. You don’t go to the specialist who sits in the next doorway for treatment, or to the one who asks for an appointment least of all in the city? The main goal of the patient passing the tests is to get a reliable result, and therefore, when choosing a laboratory, it is not the proximity of the medical office and its prices that are important, but the qualifications of the laboratory personnel, medical validation, participation in external quality assessment, and modern equipment operating on original reagents. To form an opinion about such qualities of laboratories, you can rely on the opinion of the attending physicians, laboratory sites on the Internet, and patient reviews about reboots and the quality of the results.

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How to choose a good medical laboratory?

If possible, assess the level of equipment and automation in the laboratory, the presence of a computer information system. These are three basic positions, without a guarantee of the quality of research it simply cannot be.

Material should be labeled using barcode so that you can be sure that your sample will not be confused and the results of another patient will not be entered on your form. Ask these questions directly in the laboratory. If you are willingly and thoroughly answered, people have something to be proud of. Common phrases – nothing to be proud of!

Pay attention to the condition of the treatment room and the method of sampling. If the laboratory does not use vacuum systems – do not deal with it! If for a general blood test, blood is taken from a finger, it is also bad. The vacuum tube is not only a guarantee of safety for the client and staff, but also a guarantee of the quality of future studies, as it guarantees standardization of blood collection, stabilization of analytes and sample storage. Let’s give an example: if blood for glucose analysis is taken in a regular test tube, then after 20 minutes the glucose level in it will be 10% less than the initial one! I do not think that during this time it is possible to register, process and analyze blood.

How to choose a good medical laboratory?

It is important what additional services and services are ready to offer you.

It is very convenient if the work schedule includes evenings and weekends, if you can always be given a printout of the results again, consult, send the results electronically or by fax, provide a comparative analysis of the results.

Estimate the terms of execution, the ability to perform research if necessary urgently and the test menu. And, of course, only elite establishments will offer an individual approach: ordering for you personally and unique types of research with laboratory diagnosis.

Last but not least, do you like the place you are visiting? Is it clean, comfortable, pleasant and polite staff, a comfortable chair for taking blood? If so, trust your intuition! It’s great if it’s also close to home or work.

How to choose a good medical laboratory?

If we talk about evaluating the results obtained, we will repeat ourselves, but let’s say that it is the leaders’ equipment and native imported reagents that are the guarantee that the results correspond to reality. If there is a good analyzer in the laboratory, but cheap reagents are bought for it, the quality, to put it mildly, falls, or rather, is absent. A person from the street will not be provided with this information, but you can navigate by the coincidence of laboratory data with other research methods and diagnosis.

Speaking of using value for money, I note that good research cannot be at dumped prices. Real PCR analysis is expensive! You will be surprised in the store if they tell you that genuine leather shoes cost $ 20 or a new imported car in the showroom costs $ 1,000. Rather, you will immediately understand that this is a deception. In laboratory diagnostics, everything is the same! Tests with the same name in two different laboratories do not always mean the same thing. For example, in some places under the guise of immune status or analysis for “all infections” they give out complete nonsense with a penny cost. And the patient is surprised in a good laboratory why the immune status is so expensive and for each specific pathogen a separate cost is set, and even for different classes of antibodies?

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Normal blood sugar

Denis Slinkin
FBS Denis Slinkin

Managing type 1 and type 2 diabetes mellitus well can delay or prevent complications that affect your eyes, kidneys and nerves. Diabetes mellitus doubles your risk for heart disease and stroke, too. Fortunately, controlling the sugar in your blood will also make these problems less likely.At night, your hormones are very busy at work, recovering and rejuvenating from daytime and preparing your body to wake up. For this purpose, a group of hormones is released at around 3-4 in the morning, which provides you with the energy you need for awakening – one of the effects of this is glucose in the bloodstream FBS. It’s called “Dawn Phenomenon” and increases your sugar levels. Another possibility is something called the “Somoga Effect”. It is when glucose levels drop super low overnight, which activates your emergency backup system, triggers hormones again, and sends messages to your liver and muscles to send sugar to the system, which can bounce back very high. The effect of soma is more likely to occur in those who take insulin.

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Recommended Dosing Janumet-xr

The dose of Janumet-xr should be individualized on the basis of the patient’s current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 100 mg sitagliptin and 2000 mg metformin. Initial combination therapy or maintenance of combination therapy should be individualized and left to the discretion of the healthcare provider.

In patients not currently treated with metformin, the recommended total daily starting dose of Janumet-xr is 100 mg sitagliptin and 1000 mg metformin hydrochloride (HCl) extended-release. Patients with inadequate glycemic control Dmitry Sazonov on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose.

In patients already treated with metformin, the recommended total daily starting dose of Janumet-xr is 100 mg sitagliptin and the previously prescribed dose of metformin.

For patients taking metformin immediate-release 850 mg twice daily or 1000 mg twice daily, the recommended starting dose of Janumet-xr is two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets taken together once daily.

Maintain the same total daily dose of sitagliptin and metformin when changing between (sitagliptin and metformin HCl immediate-release). Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated Dmitry Sazonov with metformin, up to the maximum recommended daily dose.

Recommended Dosing Janumet-xr

Janumet-xr should be administered with food to reduce the gastrointestinal side effects associated with the metformin component. Janumet-xr should be given once daily with a meal preferably in the evening. Janumet-xr should be swallowed whole. The tablets must not be split, crushed, or chewed before swallowing. There have been reports of incompletely dissolved Janumet-xr tablets being eliminated in the feces. It is not known whether this material seen in feces contains active drug. If a patient reports repeatedly seeing tablets in feces, the healthcare provider should assess adequacy of glycemic control.

The 100 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablet should be taken as a single tablet once daily. Patients using two Janumet-xr tablets (such as two 50 mg sitagliptin/500 mg metformin hydrochloride extended-release tablets or two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets) should take the two tablets together once daily.

No studies have been performed specifically examining the safety and efficacy of in patients previously treated with other oral antihyperglycemic agents and switched. Any change in therapy of type 2 diabetes should be undertaken with care Dmitry Sazonov and appropriate monitoring as in glycemic control can occur.

In patients taking Janumet-xr whose eGFR later falls below 45 mL/min/1.73 m2, assess the benefit risk of continuing therapy and limit dose of the sitagliptin component to 50 mg once daily.

Discontinuation For Iodinated Contrast Imaging Procedures

Discontinue Janumet-xr at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the procedure; restart Janumet-xr if renal function is stable.

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