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When to contact your GP or diabetes specialist nurse: If you've been taking expired Rybelsus and notice worsening blood glucose control If you experience unexplained symptoms such as persistent thirst, increased urination, or fatigue If you're unable to obtain a fresh supply of your medication For advice on alternative diabetes management strategies if Rybelsus is temporarily unavailable Seek urgent medical advice (call NHS 111) or emergency care (999) if you experience: Severe dehydration (extreme thirst, dry mouth, little or no urination) Confusion or drowsiness Rapid breathing Severe abdominal pain or persistent vomiting Very high blood glucose levels that don't respond to usual treatment These could be signs of severe hyperglycaemia or hyperosmolar hyperglycaemic state (HHS), which requires immediate medical attention

Neonatal blood concentrations of metformin have been found to equal or surpass half of maternal levels, raising concerns about the potential impact of elevated metformin levels on neonatal glucose metabolism and the development of hypoglycemia in newborns

Effect of porcine gastric inhibitory polypeptide on beta-cell function in type I and type II diabetes mellitus

Alcohol: Caution is advised when consuming alcohol with Janumet, as it can potentiate the risk of lactic acidosis