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You should not use Januvia if you are in a state of diabetic ketoacidosiscall your doctor for treatment with insulin

Before you start taking JANUVIAtell your doctor if you have ever had heart failureyour heart does not pump blood well enoughor have problems with your kidneysContact your doctor right away if you have increasing shortness of breath or trouble breathingespecially when you lie downswelling or fluid retentionespecially in the feetanklesor legsan unusually fast increase in weightor unusual tirednessThese may be symptoms of heart failure.

If you take JANUVIA with another medicine that can cause low blood sugarhypoglycemiasuch as a sulfonylurea or insulinyour risk of getting low blood sugar is higherThe dose of your sulfonylurea medicine or insulin may need to be lowered while you use JANUVIASigns and symptoms of low blood sugar may include headachedrowsinessweaknessdizzinessconfusionirritabilityhungerfast heart beatsweatingand feeling jittery.

Get emergency medical help if you have signs of an allergic reaction to Januviahivesdifficult breathingswelling in your face or throator a severe skin reactionfeversore throatburning in your eyesskin painred or purple skin rash that spreads and causes blistering and peeling

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