vildagliptin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
vildagliptin: clinical details
Prescribing considerations
- Confirm type 2 diabetes; vildagliptin is not a substitute for insulin where insulin is required.
- Assess renal and hepatic function before prescribing.
- Use caution with a history of acute pancreatitis and do not restart if pancreatitis is confirmed.
- Clinical experience is limited in advanced heart failure, and use is not recommended in NYHA class IV.
- Review the risk of hypoglycaemia when combined with insulin or a sulfonylurea.
- Monitor for blistering, ulceration or exfoliative skin disease.
Contraindications and cautions
- Hypersensitivity to vildagliptin or any excipient.
- Hepatic impairment, including pretreatment ALT or AST above three times the upper limit of normal.
- The selected product contains lactose and should not be used in specified rare hereditary disorders of galactose metabolism or absorption.
Monitoring
- Obtain baseline liver function tests.
- Monitor liver function at three-month intervals during the first year and periodically thereafter.
- Confirm raised transaminases and monitor more frequently until resolved; discontinue if elevation at or above three times the upper limit of normal persists.
- Stop for jaundice or other evidence of liver dysfunction and do not restart after liver tests normalise.
- Monitor glycaemic response, renal function and the skin as clinically appropriate.
Clinical pharmacology
Vildagliptin is a potent, selective DPP-4 inhibitor. It is rapidly absorbed, undergoes mainly hydrolytic metabolism rather than CYP450 metabolism, and its metabolites and unchanged medicine are substantially eliminated in urine.
Formulation and product differences
- The selected product is an oral, immediate-release tablet.
- The tablet contains lactose as an excipient.
- Fixed-dose vildagliptin–metformin products have separate product-specific administration, renal and contraindication requirements and are not interchangeable without prescription review.
vildagliptin preparations and strengths
Tablet
Route: Oral
Strengths: 50 mg
vildagliptin interactions
Vildagliptin has relatively low potential for CYP-mediated interactions, but clinically relevant combinations still require attention.
ACE inhibitors, such as ramipril
Concurrent use may increase the risk of angioedema.
Sulfonylureas
The combination increases the risk of low blood glucose and may require review of the sulfonylurea prescription.
Insulin
Low blood glucose has been reported during combined treatment, so glucose control should be reviewed appropriately.
Thiazide diuretics, corticosteroids, thyroid hormones and sympathomimetics
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.