Vildagliptin with metformin

How it works

Vildagliptin inhibits DPP-4 to enhance incretin-mediated, glucose-dependent insulin secretion and suppress glucagon, while metformin reduces hepatic glucose production and improves insulin sensitivity.

Prescribing in practice

• The metformin component requires renal function review and temporary withholding during acute illness, dehydration, or before iodinated contrast, due to the rare risk of lactic acidosis.
• Vildagliptin requires liver function testing before and periodically during treatment, as rare hepatic dysfunction has been reported; it may also rarely cause pancreatitis.
• Metformin commonly causes gastrointestinal upset, reduced by taking with food.

Monitoring

Monitor liver function and renal function alongside HbA1c, and review for gastrointestinal tolerance and signs of pancreatitis.

Counselling the patient

• Take with or after food to reduce stomach upset.
• Report any yellowing of the skin or eyes, dark urine, or persistent fatigue.
• Stop temporarily and seek advice during severe illness, dehydration, or before a contrast scan.

Evidence & guidelines

Vildagliptin product information specifies baseline and periodic liver function monitoring, and NICE supports DPP-4 inhibitors as recognised add-ons to metformin in type 2 diabetes.