Initial therapy in type 2 DM when diet & exercise do not provide adequate glycemic control. Adjunct to diet & exercise to improve glycemic control in type 2 DM inadequately controlled on metformin or sitagliptin alone, or combination sitagliptin & metformin, or triple combination sitagliptin, metformin or sulfonylurea, or max tolerated dose of metformin & PPARγ agonist, or insulin & metformin alone.
Not for use in type 1 DM or treatment of ketoacidosis. Sulfonylurea- or insulin-induced hypoglycemia, risk of lactic acidosis, hypoxic states, surgery, alcohol intoxication, decreased vit B12 absorption, loss of glycemic control. Renal & hepatic impairment. Childn <18 yr. Elderly.
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