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When taken orally, the B12 supplement must pass through the digestive tract, where it relies heavily on the presence of intrinsic factor, a protein in the stomach, to facilitate absorption

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Clinical recommendations based upon the patient's renal function include [see Dosage and Administration (2.2), Clinical Pharmacology (12.3)]: Before initiating JANUMET XR, obtain an estimated glomerular filtration rate (eGFR)

The impact of long-term effects is not studied yet

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If nausea is severe enough to prevent adequate nutrition, reduce both compounds to the last tolerated dose and extend the stabilization period before attempting re-escalation