Yes, Fixed-Dose Combination Tablets of Vildagliptin and Metformin Are Available
A fixed-dose combination tablet containing vildagliptin and metformin (marketed as Eucreas® or Galvumet®) is available in multiple strengths, including formulations with metformin extended-release. 1, 2
Available Formulations
The vildagliptin/metformin fixed-dose combination is available in the following strengths:
- 50 mg vildagliptin / 500 mg metformin 3
- 50 mg vildagliptin / 850 mg metformin 3
- 50 mg vildagliptin / 1,000 mg metformin 3
These fixed-dose combinations have been proven bioequivalent to taking the individual tablets separately, meaning they provide identical therapeutic effects while improving convenience and potentially enhancing medication adherence. 3
Clinical Rationale for This Combination
The combination of vildagliptin (a DPP-4 inhibitor) and metformin addresses multiple pathophysiological defects in type 2 diabetes through complementary mechanisms:
- Metformin decreases hepatic glucose production and improves insulin sensitivity 4
- Vildagliptin enhances pancreatic islet function by improving insulin secretion and suppressing inappropriate glucagon secretion 5
The American Diabetes Association guidelines support early combination therapy with metformin and DPP-4 inhibitors like vildagliptin, particularly noting that the VERIFY trial demonstrated slower decline in glycemic control with initial combination therapy compared to sequential addition of medications. 6
Efficacy and Safety Profile
When added to metformin, vildagliptin provides an additional HbA1c reduction of approximately 0.7-1.0%. 6, 2
Key safety advantages of this combination include:
- Minimal hypoglycemia risk due to the glucose-dependent mechanism of action 5, 1
- Weight neutral - does not promote weight gain 5, 1
- No clinically significant pharmacokinetic interactions between the two drugs 7
- Well tolerated, with the most common adverse events being mild gastrointestinal effects from metformin 3
Practical Considerations
If gastrointestinal intolerance occurs with standard metformin, extended-release formulations can be considered to improve tolerability. 4
The fixed-dose combination tablet offers several practical advantages:
- Improved medication adherence by reducing pill burden 5, 3
- Therapeutically equivalent and exchangeable with free combination therapy 3
- Can be used without dose adjustment when switching from separate tablets 7
When to Consider This Combination
Initial combination therapy with metformin and vildagliptin should be considered in patients presenting with HbA1c levels 1.5-2.0% above target for more rapid attainment of glycemic goals. 6
This combination is particularly appropriate for patients who:
- Require dual therapy but want to minimize hypoglycemia risk 5
- Are concerned about weight gain 5, 1
- Need improved medication adherence through simplified regimens 5, 3
However, for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, an SGLT2 inhibitor or GLP-1 receptor agonist with demonstrated cardiovascular benefit should be prioritized over vildagliptin. 4, 8