{"id":48515,"date":"2022-02-03T13:49:04","date_gmt":"2022-02-03T18:49:04","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=48515"},"modified":"2025-08-20T14:31:50","modified_gmt":"2025-08-20T18:31:50","slug":"janumet-side-effects","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/janumet-side-effects\/","title":{"rendered":"Janumet side effects and how to avoid them"},"content":{"rendered":"<p><span style=\"font-weight: 400;\"><a href=\"#common-janumet-side-effects\">Common Janumet side effects<\/a> | <a href=\"#diarrhea\">Diarrhea<\/a> | <a href=\"#b12-deficiency\">B12 deficiency<\/a> | <a href=\"#serious-side-effects\">Serious side effects<\/a> | <a href=\"#lactic-acidosis\">Lactic acidosis<\/a> | <a href=\"#pancreatitis\">Pancreatitis<\/a> | <a href=\"#how-long-do-side-effects-last\">How long do side effects last?<\/a> | <a href=\"#warnings\">Warnings<\/a> | <a href=\"#interactions\">Interactions<\/a> | <a href=\"#how-to-avoid-side-effects\">How to avoid side effects<\/a><\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/janumet\"><span style=\"font-weight: 400;\">Janumet<\/span><\/a><span style=\"font-weight: 400;\"> (sitagliptin\/metformin) combines two distinct classes of diabetes medication into one pill to treat <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/type-2-diabetes-treatment-and-medications\"><span style=\"font-weight: 400;\">Type 2 diabetes mellitus<\/span><\/a><span style=\"font-weight: 400;\">. Sitagliptin, available as brand-name <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/januvia\"><span style=\"font-weight: 400;\">Januvia<\/span><\/a><span style=\"font-weight: 400;\">, is a dipeptidyl peptidase-4 (DPP-4) inhibitor that increases glucagon-like peptide 1 (GLP-1) levels to reduce the rise in blood sugar levels after meals. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/metformin\"><span style=\"font-weight: 400;\">Metformin<\/span><\/a><span style=\"font-weight: 400;\">\u00a0reduces hepatic (liver) production of glucose and improves peripheral body tissue use of glucose. Janumet is available as a twice-a-day formulation or as a once-a-day formulation called <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/janumet-xr\"><span style=\"font-weight: 400;\">Janumet XR<\/span><\/a><span style=\"font-weight: 400;\">. Part of the attraction to this combination is the lack of weight gain and hypoglycemia (low blood sugar). However, Janumet is not devoid of serious potential side effects.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/prescription\/janumet\/what-is\"><b>What is Janumet?<\/b><\/a><\/p>\n<h2 id=\"common-janumet-side-effects\"><span style=\"font-weight: 400;\">Common side effects of Janumet<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The following are the <\/span><a href=\"https:\/\/online.epocrates.com\/drugs\/465705\/Janumet\/Adverse-Reactions\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">most common<\/span><\/a><span style=\"font-weight: 400;\"> Janumet side effects:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diarrhea or flatulence<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nausea or vomiting<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Abdominal discomfort (stomach pain), dyspepsia (upset stomach), or indigestion<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vitamin B12 deficiency<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Asthenia (lack of energy or weakness)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headache<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Arthralgia (joint pain)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Upper respiratory tract infection<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Rash<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anorexia (loss of appetite)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Metallic taste<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ovulation induction<\/span><\/li>\n<\/ul>\n<h3 id=\"diarrhea\"><span style=\"font-weight: 400;\">Diarrhea<\/span><\/h3>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/conditions\/diarrhea-treatment-and-medications\">Diarrhea<\/a> is the most common side effect of Janumet and derives from the metformin component. Almost 8% of users experienced diarrhea in <\/span><a href=\"https:\/\/www.merck.com\/product\/usa\/pi_circulars\/j\/janumet\/janumet_pi.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">one study<\/span><\/a><span style=\"font-weight: 400;\">, compared to 4% of those taking placebo (inactive pills used for comparison). In fact, gastrointestinal side effects as a group make up the bulk of the common adverse effects of Janumet. Slowly titrating up on the dose, taking a break from the drug when needed, or switching to an extended-release form could help to alleviate diarrhea from Janumet.<\/span><\/p>\n<h3 id=\"b12-deficiency\"><span style=\"font-weight: 400;\">B12 deficiency<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In a 29-week clinical trial, about 7% of those using Janumet developed vitamin B12 deficiency. The cause is thought to be metformin-associated impairment of the nutrient\u2019s absorption. Symptoms of low vitamin B12 include anemia, glossitis (swollen and painful tongue), neuropathy (nerve dysfunction), and cognitive slowing. Vitamin supplementation or Janumet stoppage can help to reverse these effects.<\/span><\/p>\n<h2 id=\"serious-side-effects\"><span style=\"font-weight: 400;\">Serious side effects of Janumet<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lactic acidosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Megaloblastic anemia (resulting from B12 deficiency)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypersensitivity allergic reactions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anaphylaxis (severe life-threatening allergic reaction)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Angioedema (allergy-related swelling)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stevens-Johnson syndrome (severe allergic skin rash with blisters)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pancreatitis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heart failure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Acute renal failure (abrupt decline in kidney function)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severe arthralgia (severe joint pain)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bullous pemphigoid (rash with blisters)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Rhabdomyolysis (muscle tissue breakdown)<\/span><\/li>\n<\/ul>\n<h3 id=\"lactic-acidosis\"><span style=\"font-weight: 400;\">Lactic acidosis<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The Food and Drug Administration (FDA) has a black box warning, its highest level label, on Janumet to call attention to the potential for lactic acidosis. The condition is associated with a biochemical imbalance in the bloodstream, with excess lactate leading to acidosis. Symptoms can include malaise (a general ill feeling), abdominal pain, myalgias (muscle pain), somnolence, and trouble breathing. Ultimately, it can result in hypothermia, hypotension (low blood pressure), and death.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The concern for lactic acidosis with Janumet originates from the metformin component and comes from case reports of this condition occurring in the setting of the medication. The following are some risk factors for lactic acidosis that the FDA has identified:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Renal impairment (kidney problems)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain concurrent drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Age 65 or older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A radiologic study with contrast (intravenous dye)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Surgery<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypoxic (<a href=\"https:\/\/www.singlecare.com\/blog\/blood-oxygen-levels\/\">low oxygen<\/a>) states like congestive heart failure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Excessive alcohol intake<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hepatic impairment (liver dysfunction)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Avoiding the use of Janumet in the setting of these risk factors may be necessary, and certainly, if lactic acidosis is suspected and found to be present, the FDA recommends prompt hospital-based treatment and dialysis.<\/span><\/p>\n<h3 id=\"pancreatitis\"><span style=\"font-weight: 400;\">Pancreatitis<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Case reports have also surfaced about <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/pancreatitis-treatment-and-medications\"><span style=\"font-weight: 400;\">pancreatitis<\/span><\/a><span style=\"font-weight: 400;\"> with the use of sitagliptin. Pancreatitis (inflammation of the pancreas) consists of abdominal pain as the prominent symptom, and fatal cases have occurred among sitagliptin users. However, when clinical trial data was examined, no heightened risk of pancreatitis was seen among sitagliptin users compared to placebo. The concern persists. Janumet should be discontinued, and treatment sought if pancreatitis arises.<\/span><\/p>\n<h2 id=\"how-long-do-side-effects-last\"><span style=\"font-weight: 400;\">How long do Janumet side effects last?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The common gastrointestinal side effects of Janumet may resolve despite medication continuation in a matter of days to weeks, or they may respond to a dose reduction. B12 deficiency can develop over the long term but resolves with supplementation. Others, like arthralgia, may resolve with discontinuation of the drug. The most severe, such as anaphylaxis and lactic acidosis, require emergency treatment in addition to discontinuing the drug. Signs of an allergic reaction to Janumet include shortness of breath, <a href=\"https:\/\/www.singlecare.com\/conditions\/hives-treatment-and-medications\">hives,<\/a> and swelling of the face, lips, tongue, or throat. Seek immediate medical help in the event of an allergic reaction.<\/span><\/p>\n<h2 id=\"warnings\"><span style=\"font-weight: 400;\">Janumet contraindications and warnings<\/span><\/h2>\n<h3><span style=\"font-weight: 400;\">Abuse and dependence<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0Janumet is not habit-forming, and discontinuation generates no withdrawal symptoms.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Overdose<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The maximum dose of Janumet for most is 50 mg\/1000 mg twice daily. An overdose can create dangerous adverse effects, possibly lactic acidosis, so seeking medical attention and calling the Poison Help line at 1-800-222-1222 is appropriate.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Restrictions<\/span><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Janumet is not indicated for children.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Women who are pregnant or breastfeeding should exert caution and seek medical advice about the possible risks and benefits of Janumet use, principally due to the lack of clinical trial data on sitagliptin use in these situations.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A number of medical conditions are contraindications to Janumet use, meaning that Janumet should be avoided. These conditions include:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Renal impairment with a glomerular filtration rate (GFR) of less than 30<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">A history of hypersensitivity to the drug<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/blog\/type-1-vs-type-2-diabetes\/\">Type 1 diabetes<\/a> mellitus or diabetic ketoacidosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Metabolic or lactic acidosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Hypoxemia (low blood oxygen content)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Dehydration<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/conditions\/sepsis-treatment-and-medications\">Sepsis<\/a> (a life-threatening condition from infection)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Surgery<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Liver disease<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In addition, Janumet is typically not begun in the setting of <a href=\"https:\/\/www.singlecare.com\/blog\/chronic-kidney-disease\/\">kidney disease<\/a> with a GFR of 30 to 45.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cautious consideration prior to use is worthwhile for anyone with:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Congestive heart failure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Alcohol abuse<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">A history of pancreatitis<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Based on higher rates of lactic acidosis and conditions which elevate the risk of adverse events, seniors should be more cautious about taking Janumet as well.<\/span><\/li>\n<\/ul>\n<h2 id=\"interactions\"><span style=\"font-weight: 400;\">Janumet interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A lengthy list of medications could <\/span><a href=\"https:\/\/online.epocrates.com\/drugs\/465704\/Janumet\/Drug-Interactions\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">interact with Janumet <\/span><\/a><span style=\"font-weight: 400;\">and warrant monitoring or modification of therapy. Other Type 2 diabetes medicines may combine with Janumet to generate hypoglycemia.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Additional DPP-4 inhibitor drugs should not be used with Janumet. Since DPP-4 inhibitors do not add more diabetic control benefits on top of <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/glp-1-agonists\"><span style=\"font-weight: 400;\">GLP-1 agonists<\/span><\/a><span style=\"font-weight: 400;\">, the two classes are not used together, and therefore a GLP-1 agonist would not be used with Janumet.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some drugs can cause hyperglycemia (high blood sugar) when combined with Janumet. These include thiazides and other diuretics, corticosteroids, phenothiazines, thyroid medications, estrogens, oral contraceptives (birth control), phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Most importantly, the following drugs are to be avoided when Janumet is used, due to a heightened risk of lactic acidosis:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Acetazolamide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Topiramate<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Risdiplam<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tafenoquine<\/span><\/li>\n<\/ul>\n<h2 id=\"how-to-avoid-side-effects\"><span style=\"font-weight: 400;\">How to avoid Janumet side effects<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sit down with your healthcare provider before starting Janumet and follow up regularly while taking the drug. Review your list of prescription medication, over-the-counter drugs, and supplements to check for drug interactions. Go over your history of medical conditions to look for any contraindications to Janumet use.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Take Janumet with meals. Take the medication exactly as directed.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If a dose is missed and you remember soon after it was due, you can take it, but if the next dose is coming soon, skip the missed dose. Do not take an extra dose to make up for a missed dose.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Swallow the tablet whole, and do not chew, break, or crush it. Refer to the medication guide for more instructions on how to take Janumet.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Avoid dehydration by drinking enough fluids.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Check with the prescribing healthcare professional to see if your vitamin B12 level should be monitored.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ask the prescriber if you should <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/normal-blood-glucose-levels\/\"><span style=\"font-weight: 400;\">monitor your blood glucose levels<\/span><\/a><span style=\"font-weight: 400;\">. Understand the signs of hypoglycemia, such as weakness, sweating, shakiness, anxiety, fast heartbeat, irregular heartbeat, blurred vision, tiredness, and confusion. Have sugary drinks or food available to take in case hypoglycemia is experienced. Discuss the signs of hypoglycemia and the response to it with family, friends, and co-workers so that they may assist you if needed.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Check with your healthcare provider to know when you should temporarily stop Janumet. Possible examples of these instances would be around the time of surgery or when you are not eating or drinking well, are experiencing excessive diarrhea, have a serious infection, are consuming alcohol, or have had a radiologic study with contrast material (intravenous dye).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do not drink alcohol.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">For more drug information, contact your healthcare provider, a pharmacist, or refer to the drug manufacturer, Merck. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">SingleCare can help cover medication costs that insurance may not cover. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">Get your free prescription discount card here.<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Common Janumet side effects | Diarrhea | B12 deficiency | Serious side effects | Lactic acidosis | Pancreatitis | How long do side effects last? | Warnings | Interactions | How to avoid side effects Janumet (sitagliptin\/metformin) combines two distinct classes of diabetes medication into one pill to treat Type 2 diabetes mellitus. Sitagliptin, available [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":48636,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[10298,12752],"coauthors":[20732],"class_list":["post-48515","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-diabetes","tag-medication-side-effects","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Janumet side effects and how to avoid them<\/title>\n<meta name=\"description\" content=\"Diarrhea and vitamin B12 deficiency are common Janumet side effects. 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