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There is an increased risk of hypoglycemia when JANUVIA is added to an insulin secretagogue (e.g., sulfonylurea) or insulin therapy

doi: 10.3390/ijms232012403 51

L-Carnitine exists in several forms, including free L-Carnitine, acetyl-L-carnitine (ALCAR), and propionyl-L-carnitine (PLC)

They are significantly larger than the molecules in a typical nicotine or birth control patch, making it very difficult for them to pass through the skin's protective outer layer and into the bloodstream in a therapeutic dose

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Diarrhea and constipation also occur in significant percentages of the user population