I am not sure but after taking Januvia for about 2 1/2 months had a brain stem stroke. They could not fing anything that might have caused the stroke. I had six weeks to graduate from nursing school, and when the doctor prescribed the med to me, looking at the side effects concerned me because, at that time there was only four side effects mentioned and looking at drug guide books has a did for school drugs have many possible side effects and with these one only have four known concerned me. I guess I should be lucky to be sitting here reading this. But the first thought to my mind was the med Januvia.