<p>If pancreatitis is suspected, sitagliptin should promptly be discontinued and appropriate management should be initiated.<br />
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<strong>Use in Patients with Renal Insufficiency</strong>: Dosage adjustment is recommended in patients with moderate or severe renal insufficiency and in patients with ESRD requiring hemodialysis or peritoneal dialysis.<br />
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<strong>Use with medications known to cause Hypoglycemia</strong>: When sitagliptin is used in combination therapy dosage adjustment of sulfonylurea or insulin may be required to reduce the risk of hypoglycemia.<br />
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<strong>Hypersensitivity Reactions</strong>: There have been post-marketing reports of serious hypersensitivity reactions in patients treated with sitagliptin. These reactions include anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. If a hypersensitivity reaction is suspected, discontinue sitagliptin, assess for other potential causes for the event, and institute alternative treatment for diabetes.</p>