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These include: Nausea and vomiting often mild to moderate and typically improving over several weeks Diarrhoea or constipation affecting bowel habits in some individuals Abdominal discomfort or pain usually transient Reduced appetite which may be beneficial for weight management but can be troublesome for some These gastrointestinal effects are generally less pronounced with Januvia, though some people may experience mild nausea or abdominal discomfort