Vildagliptin

How it works

It inhibits the DPP-4 enzyme, preventing the breakdown of the incretin hormones GLP-1 and GIP, which increases glucose-dependent insulin secretion and suppresses glucagon release.

Prescribing in practice

• Rare but serious hepatic dysfunction has been reported, so liver function should be checked before and periodically during treatment, and it should not be started in those with hepatic impairment or raised liver enzymes.
• Hypoglycaemia is uncommon on its own but the risk increases when combined with a sulfonylurea or insulin, which may need dose reduction.
• Acute pancreatitis has been reported, so it should be stopped if pancreatitis is suspected.

Monitoring

Monitor HbA1c for glycaemic response and liver function before and during treatment, and review for symptoms suggestive of pancreatitis.

Counselling the patient

• Take the tablets as directed, with the timing your clinician advises.
• Report persistent severe abdominal pain, or yellowing of the skin or eyes.
• Low blood sugar is unlikely unless you also take certain other diabetes medicines.

Evidence & guidelines

Its glucose-lowering efficacy was demonstrated in randomised controlled trials in type 2 diabetes supporting its regulatory approval.