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These include: Severe abdominal pain (potentially indicating pancreatitis)stop the medication immediately and seek urgent medical care Persistent vomiting leading to dehydration Visual changes or severe headaches Persistent or symptomatic rapid heart rate or palpitations Signs of allergic reaction (rash, difficulty breathing, facial swelling) Symptoms of gallbladder disease (right upper quadrant pain, especially after meals) Maintain a medication diary noting the date, time, and dose of each injection, along with any missed doses

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moderate renal impairment (eGFR 30-45 ml/min) has been observed to increase plasma levels of sitagliptin 2-fold, and severe renal impairment can increase plasma levels 4-fold