Dosing and Safety of Janumet 50/500

Dose Titration and Renal Impairment

The American College of Physicians recommends metformin may be safely used in patients with estimated glomerular filtration rate as low as 30 mL/min/1.73 m² 1
The American College of Physicians suggests that metformin should be discontinued if patients experience nausea, vomiting, or dehydration to prevent lactic acidosis 1
The American College of Physicians advises against starting metformin at full dose (1000 mg twice daily) immediately, as this increases gastrointestinal side effects—start at 500 mg twice daily and titrate gradually 1
The American College of Physicians recommends against continuing metformin in patients with eGFR <30 mL/min/1.73 m² due to increased risk of lactic acidosis 1

The American College of Physicians recommends monitoring vitamin B12 levels periodically in long-term metformin users, especially those with anemia or peripheral neuropathy 1, 2