Vildagliptin+ Metformin

Indications & Dose:

Type 2 diabetes mellitus not controlled by metformin alone or by metformin in combination with either a sulfonylurea or insulin

• BY MOUTH

Adult: Initially, based on current metformin dose, 50 mg/850 mg or 50 mg/1000 mg twice daily (morning and evening) with or just after food. For patients eceiving components as separate tab, switch to equivalent dosage. Recommended daily dose, 100 mg/2000 mg.

Children: Not recommended.

Contraindications:

Diabetic ketoacidosis or pre-coma. Renal or hepatic impairment. Acute conditions predisposing to renal impairment (e.g. dehydration, severe infection, shock). Cardiac or respiratory failure, recent MI. Acute alcohol intoxication, alcoholism, Discontinue for 48 hours before and after surgery. Patients > 75 years of age.

Side Effects:

Cautions:

Precautions:

Assess risk factors for lactic acidosis; discontinue immediately if metabolic acidosis suspected. Monitor serum creatinine at least annually (2-4 times a year in elderly and patients with serum creatinine levels at ULN). Measure liver enzymes before treatment, every 3 months during first year then periodically. If transaminase levels increased, monitor frequently until return to normal; withdraw and do not restart if persistent increase of ALT or AST >3 times ULN, or if patient develops jaundice or other signs of liver dysfunction.

Interaction:

Alcohol, cimetidine, iodinated contrast agents, corticosteroids, beta2-agonists, diuretics, ACE inhibitors.

Warnings:

Adverse Effects:

GI upset, metallic taste, tremor, headache, dizziness, hypoglycaemia. Rarely, hepatic dysfunction (including hepatitis), lactic acidosis (discontinue), skin reactions angioedemia, reduced vit. B12 absorption.

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: