Vigatin50 mg

Vigatin is a dipeptidyl peptidase-4 (DPP-4) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Established / Guideline-Supported Uses

• Monotherapy: When diet and exercise alone do not provide adequate glycemic control and metformin is not appropriate (e.g. due to contraindication or intolerance).
• Dual combination therapy: Added to metformin, a sulphonylurea, a thiazolidinedione, or insulin when the single agent, together with diet and exercise, does not provide adequate control.
• Triple combination: May be used with metformin plus a sulphonylurea when this combination alone does not provide adequate glycemic control.

Not Indicated

Vigatin is not indicated for type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.

Each film-coated tablet contains Vildagliptin 50 mg as the active ingredient, along with pharmaceutically inert excipients such as microcrystalline cellulose, anhydrous lactose, sodium starch glycolate, and magnesium stearate.

Vigatin is an oral antidiabetic agent belonging to the dipeptidyl peptidase-4 (DPP-4) inhibitor class, sometimes called "gliptins." It works by increasing levels of incretin hormones, which help the body release insulin appropriately after meals and reduce excess glucose production by the liver.

Vigatin is used as part of a comprehensive treatment plan for type 2 diabetes that includes diet and exercise, either alone or together with other antidiabetic medicines.

Vigatin belongs to the Dipeptidyl Peptidase-4 (DPP-4) Inhibitor class of oral antidiabetic (anti-hyperglycemic) agents, also known as “gliptins.”

Mechanism of Action

Vildagliptin inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which is responsible for breaking down the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). By slowing the degradation of these hormones, Vildagliptin increases their circulating levels, which in turn increases glucose-dependent insulin secretion from pancreatic beta cells and decreases inappropriate glucagon secretion from alpha cells, reducing hepatic glucose output.

Pharmacokinetics

Vildagliptin is rapidly absorbed after oral administration, with peak plasma concentration reached within about 1-2 hours. Absolute bioavailability is approximately 85%. It is partially metabolized (mainly by hydrolysis, not primarily via cytochrome P450 enzymes) and is eliminated roughly 85% in urine and 15% in feces, with an elimination half-life of about 2-3 hours.

Vigatin is administered orally, with or without food, at approximately the same time(s) each day. Tablets should be swallowed whole with water and should not be crushed or chewed unless otherwise directed by a physician.

Vigatin has a low potential for drug interactions, as it is not a substrate of, nor a significant inhibitor or inducer of, cytochrome P450 enzymes. The following interactions are clinically relevant:

• Sulphonylureas and insulin: Combining Vigatin with these agents increases the risk of hypoglycemia; a lower dose of the sulphonylurea or insulin may be needed.
• ACE inhibitors: A possible increased risk of angioedema has been reported when Vigatin is used with ACE inhibitors; patients should be monitored for facial or airway swelling.
• Thiazide diuretics, corticosteroids, thyroid hormone products, and sympathomimetics: These may reduce the glucose-lowering effect of Vigatin, potentially requiring dose adjustment of the diabetes regimen.

No clinically significant interactions have been identified with metformin, pioglitazone, glyburide, digoxin, warfarin, amlodipine, ramipril, valsartan, or simvastatin. Patients should inform their physician of all medicines they are taking, including over-the-counter drugs and herbal supplements.

Adverse effects of Vigatin are generally mild and transient. Common and serious effects include:

Common (may affect up to 1 in 10 people)

• Dizziness
• Headache
• Tremor
• Nausea
• Peripheral edema (swelling of hands/feet), particularly when combined with a thiazolidinedione
• Hypoglycemia (mainly when combined with a sulphonylurea or insulin — see Interactions)

Uncommon to Rare but Clinically Important

• Liver enzyme elevation and, rarely, hepatitis or liver dysfunction (see Precautions and Warnings)
• Acute pancreatitis (see Precautions and Warnings)
• Skin reactions including blistering and, rarely, bullous pemphigoid (see Precautions and Warnings)
• Joint pain (arthralgia)
• Upper respiratory tract infection symptoms

Patients should seek prompt medical attention for persistent abdominal pain, yellowing of the skin/eyes, unusual fatigue, or unexplained blistering of the skin.

Pregnancy

There are limited human data on the use of Vigatin during pregnancy. Animal studies have shown reproductive toxicity at high doses. As a precaution, Vigatin should not be used during pregnancy unless clearly necessary; if a patient becomes pregnant or plans to become pregnant, insulin therapy is generally preferred, and a physician should be consulted to reassess the treatment plan.

Lactation

It is not known whether Vigatin is excreted in human breast milk. Because a risk to the breastfeeding infant cannot be excluded, Vigatin should not be used while breastfeeding; a physician should be consulted to select an appropriate alternative.

Hepatic Effects

Rare cases of liver dysfunction, including hepatitis, have been reported with Vigatin. Liver function tests are recommended before starting Vigatin, at three-month intervals during the first year of treatment, and periodically thereafter. If ALT or AST rises to 3 times the upper limit of normal or greater (confirmed on repeat testing), or if jaundice or other signs of liver dysfunction develop, Vigatin should be discontinued and not restarted.

Pancreatitis

Cases of acute pancreatitis have been reported with Vigatin. Patients should be counseled on the characteristic symptom of persistent, severe abdominal pain. If pancreatitis is suspected, Vigatin should be discontinued promptly; if confirmed, it should not be restarted.

Skin Reactions / Bullous Pemphigoid

Rare cases of bullous and exfoliative skin lesions, including bullous pemphigoid, have been reported. Patients should be advised to report any blistering or skin ulceration, and Vigatin should be discontinued if bullous pemphigoid is suspected.

Heart Failure

Caution is advised when Vigatin is used in patients with heart failure; it is not recommended in patients with New York Heart Association (NYHA) Class IV heart failure. Patients with pre-existing heart failure should be monitored for signs of fluid retention or worsening symptoms.

Hypoglycemia

When Vigatin is combined with a sulphonylurea or insulin, the risk of hypoglycemia is increased; dose reduction of the sulphonylurea or insulin may be required (see Interactions).

Renal Impairment

Dose adjustment is required in moderate-to-severe renal impairment and end-stage renal disease (see Dosage and Administration). No adjustment is needed in mild renal impairment.

Information on overdose with Vigatin is limited. Doses of up to 400-600 mg in clinical studies were associated with muscle pain, mild and transient paraesthesia, fever, edema, and transient elevations in lipase and creatine phosphokinase, without other clinically significant effects.

In case of a suspected overdose, seek immediate medical attention or contact a poison control center. Treatment involves discontinuing Vigatin and providing supportive care and monitoring based on the patient's clinical signs; Vigatin itself is not effectively removed by hemodialysis, though a major metabolite can be. Do not attempt home treatment for a suspected overdose.

Store at room temperature (below 30°C), away from light and moisture, in the original package. Keep out of reach of children.

Elderly (65 years and older)

No dose adjustment is generally required based on age alone. Use with caution in patients aged 75 years and older, as clinical experience is more limited in this group.

Renal Impairment

No dose adjustment is needed for mild renal impairment. A reduced dose of 50 mg once daily is recommended for moderate-to-severe renal impairment or end-stage renal disease (see Dosage and Administration).

Hepatic Impairment

Vigatin is contraindicated in patients with hepatic impairment, including those with pre-treatment liver enzymes greater than 3 times the upper limit of normal (see Contraindications).

Pediatric Population

Vigatin is not recommended for use in children and adolescents under 18 years of age, as safety and efficacy have not been established in this population.

Vigatin is used for long-term, ongoing management of type 2 diabetes mellitus as part of a chronic treatment plan. There is no fixed treatment duration; therapy is continued as long as it remains effective and well tolerated, with periodic physician review of glycemic control (e.g. HbA1c) and safety monitoring (including liver function tests). Treatment should not be stopped abruptly without medical advice.

Vildagliptin is classified as an oral antidiabetic agent, specifically a Dipeptidyl Peptidase-4 (DPP-4) inhibitor (“gliptin”).

Vildagliptin works by inhibiting the DPP-4 enzyme, which prevents the rapid breakdown of the incretin hormones GLP-1 and GIP. This raises incretin levels, which increases glucose-dependent insulin release from the pancreas and suppresses excess glucagon secretion, thereby reducing blood glucose levels in a glucose-dependent manner that carries a comparatively low intrinsic risk of hypoglycemia when used alone.

Vigatin is not recommended for use in patients under 18 years of age. Safety and efficacy of Vigatin in children and adolescents have not been established, and clinical trial data in this age group are insufficient to support use. Type 2 diabetes in pediatric patients should be managed under close pediatric endocrinology supervision using therapies with established pediatric safety data.