Vildaxil Special Precautions

General: Vildagliptin [VILDAXIL] is not a substitute for insulin in insulin-requiring patients. Vildagliptin [VILDAXIL] should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.
Renal impairment: There is limited experience in patients with ESRD on haemodialysis. Therefore Vildagliptin [VILDAXIL] should be used with caution in these patients.
Hepatic impairment: Vildagliptin [VILDAXIL] should not be used in patients with hepatic impairment, including patients with pre-treatment ALT or AST >3x ULN.
Liver enzyme monitoring: Rare cases of hepatic dysfunction (including hepatitis) have been reported. In these cases, the patients were generally asymptomatic without clinical sequelae and liver function test results returned to normal after discontinuation of treatment. Liver function tests should be performed prior to the initiation of treatment with Vildagliptin [VILDAXIL] in order to know the patient's baseline value. Liver function should be monitored during treatment with Vildagliptin [VILDAXIL] at three-month intervals during the first year and periodically thereafter. Patients who develop increased transaminase levels should be monitored with a second liver function evaluation to confirm the finding and be followed thereafter with frequent liver function tests until the abnormality(ies) return(s) to normal. Should an increase in AST or ALT of 3x ULN or greater persist, withdrawal of Vildagliptin [VILDAXIL] therapy is recommended.
Patients who develop jaundice or other signs suggestive of liver dysfunction should discontinue Vildagliptin [VILDAXIL]. Following withdrawal of treatment with Vildagliptin [VILDAXIL] and LFT normalisation, treatment with Vildagliptin [VILDAXIL] should not be reinitiated.
Cardiac failure: A clinical trial of vildagliptin in patients with New York Heart Association (NYHA) functional class I-III showed that treatment with vildagliptin was not associated with a change in left-ventricular function or worsening of pre-existing congestive heart failure (CHF) versus placebo. Clinical experience in patients with NYHA functional class III treated with vildagliptin is still limited and results are inconclusive.
There is no experience of vildagliptin use in clinical trials in patients with NYHA functional class IV and therefore use is not recommended in these patients.
Skin disorders: Skin lesions, including blistering and ulceration have been reported in extremities of monkeys in non-clinical toxicology studies. Although skin lesions were not observed at an increased incidence in clinical trials, there was limited experience in patients with diabetic skin complications. Furthermore, there have been post-marketing reports of bullous and exfoliative skin lesions. Therefore, in keeping with routine care of the diabetic patient, monitoring for skin disorders, such as blistering or ulceration, is recommended.
Acute pancreatitis: Use of vildagliptin has been associated with a risk of developing acute pancreatitis. Patients should be informed of the characteristic symptom of acute pancreatitis.
If pancreatitis is suspected, vildagliptin should be discontinued; if acute pancreatitis is confirmed, vildagliptin should not be restarted. Caution should be exercised in patients with a history of acute pancreatitis.
Hypoglycaemia: Sulphonylureas are known to cause hypoglycaemia. Patients receiving vildagliptin in combination with a sulphonylurea may be at risk for hypoglycaemia. Therefore, a lower dose of sulphonylurea may be considered to reduce the risk of hypoglycaemia.