Vildamet 50/500 Tablet

Combination of a DPP-4 inhibitor and metformin for adults with type 2 diabetes when metformin alone is not enough, or to replace separate tablets; may be combined with a sulphonylurea or insulin.

Adults: one tablet twice daily with meals — vildagliptin 50 mg + metformin 500 mg, 850 mg or 1,000 mg, chosen by the current metformin dose.

Maximum: vildagliptin 100 mg + metformin 2,000 mg daily.

• eGFR 30–60: vildagliptin 50 mg once daily and reduced metformin (specialist); below 30: contraindicated.
• Not for children under 18.

• Type 1 diabetes, diabetic ketoacidosis
• eGFR below 30 ml/min
• Liver impairment (including ALT/AST above 3 times normal before treatment)
• Conditions causing acidosis or low oxygen: severe infection, dehydration, shock, heart attack, severe heart or lung failure
• Heavy alcohol use
• Before iodinated contrast or major surgery (stop temporarily)
• Allergy to vildagliptin or metformin

Common: nausea, diarrhoea, abdominal pain, tremor, headache, dizziness, metallic taste, low blood sugar (with sulphonylureas).

Less common: tiredness, constipation, joint pain, swelling.

Rare but serious: liver injury/hepatitis, lactic acidosis, pancreatitis, angioedema (especially with ACE inhibitors), blistering skin reactions, vitamin B12 deficiency with long use.

• Liver function tests before starting, every 3 months in the first year, then periodically; stop if jaundice develops.
• Check kidney function at least yearly.
• Stop and seek help with severe persistent abdominal pain.
• Hold during dehydrating illness, contrast scans or surgery.

Insulin is preferred in pregnancy. Not recommended while breastfeeding.

• Iodinated contrast (stop before and 48 hours after)
• Alcohol (lactic acidosis)
• Sulphonylureas, insulin (low sugar)
• ACE inhibitors (angioedema risk)
• Steroids, thiazides (raise sugar); NSAIDs, diuretics (kidney effects)

Lactic acidosis is the main danger (metformin) — emergency care; haemodialysis removes metformin.

Store below 30°C, dry.