Vildaglip M (Vildagliptin and Metformin) for Type 2 Diabetes Management
Vildaglip M, a fixed-dose combination of vildagliptin (DPP-4 inhibitor) and metformin, should be initiated at 50 mg/500 mg twice daily with meals, with potential titration to 50 mg/1000 mg twice daily based on glycemic response and tolerability. 1, 2
Dosage and Administration
- Initial dosage: Vildagliptin 50 mg + Metformin 500 mg twice daily
- Maximum dosage: Vildagliptin 50 mg + Metformin 1000 mg twice daily
- Administration timing: Take with meals to reduce gastrointestinal side effects
- No dose titration required for vildagliptin component (unlike some other diabetes medications)
Renal Dosage Adjustments
- eGFR ≥45 mL/min/1.73 m²: No dosage adjustment required
- eGFR 30-44 mL/min/1.73 m²: Reduce metformin component (use lowest effective dose)
- eGFR <30 mL/min/1.73 m²: Contraindicated due to metformin component 1
Clinical Efficacy
The VERIFY trial demonstrated that initial combination therapy with vildagliptin and metformin provides:
- Superior glycemic control compared to sequential therapy or monotherapy
- More durable glycemic control with slower decline over time
- Mean HbA1c reduction of 1.6-1.8% from baseline 1, 3
In patients with baseline HbA1c ≥10%, combination therapy can achieve reductions of up to 3.2% 3.
Advantages of Vildaglip M
- Complementary mechanisms of action:
- Vildagliptin: Enhances insulin secretion and decreases glucagon release
- Metformin: Reduces insulin resistance and hepatic glucose production
- Low risk of hypoglycemia compared to sulfonylurea combinations
- Weight neutral (does not cause weight gain)
- Fixed-dose combination improves medication adherence 4, 5
Common Side Effects
- Gastrointestinal effects: Bloating, abdominal discomfort, diarrhea (primarily from metformin)
- Can be mitigated by gradual dose titration and taking with meals
- Vildagliptin-specific: Generally well-tolerated with minimal side effects 2, 6
Monitoring Requirements
- Renal function: Check eGFR before initiation and at least annually (more frequently if eGFR <60 mL/min/1.73 m²)
- Liver function: Monitor liver enzymes periodically, especially with higher doses
- Vitamin B12 levels: Consider periodic testing due to potential metformin-induced deficiency 1
- HbA1c: Evaluate glycemic control every 3-6 months 1
Important Precautions
- Temporarily discontinue in situations with risk of dehydration or hypoxemia (severe infection, surgery, contrast studies)
- Avoid in patients with history of pancreatitis, alcoholism, or severe liver disease
- Not recommended during pregnancy or breastfeeding
When to Consider Alternative Therapy
For patients with:
- Established cardiovascular disease: Consider SGLT2 inhibitor or GLP-1 receptor agonist with proven cardiovascular benefit instead 1, 7
- Heart failure or CKD: SGLT2 inhibitors preferred as first add-on to metformin 1
- Need for substantial weight loss: GLP-1 receptor agonists may be more appropriate 1
Vildaglip M represents an effective combination therapy option with good tolerability profile and convenient twice-daily dosing for patients with type 2 diabetes requiring combination therapy.