Suganon Special Precautions

Concomitant administration with drugs known to cause hypoglycemia: Insulin secretagogues such as insulin or sulfonylurea may cause hypoglycemia. Thus, lowering the dose of insulin or insulin secretagogues may be required to minimize the risk of hypoglycemia in case of concomitant administration with Suganon.
Severe and disabling joint pain: Severe and disabling joint pain has been reported in patients administering other DPP-4 inhibitors in postmarketing studies. The time to onset of symptoms following initiation of drug therapy varied from 1 day to years. Patients experienced relief of symptoms upon discontinuation of the medication. Some patients had a recurrence of severe joint pain when restarted on either their original DPP-4 inhibitor medication or another DPP-4 inhibitor. Consider DPP-4 inhibitors as a possible cause of severe joint pain and discontinue Suganon if appropriate.
Bullous pemphigoid: Postmarketing cases of bullous pemphigoid requiring hospitalization have been reported with other DPP-4 inhibitor use. In reported cases, patients typically recovered with topical or systemic immunosuppressive treatment and discontinuation of the DPP-4 inhibitor. Tell patients to report development of blisters or erosions while receiving Suganon. If bullous pemphigoid is suspected, Suganon should be discontinued and referral to a dermatologist should be considered for diagnosis and appropriate treatment.