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May be used as 2nd line agent in type 2 diabetes as weight neutral and will not cause hypoglycaemia in or of itself
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Well tolerated and useful agent in elderly and/or renal disease
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Only currently known 2nd line agent in combination with metformin to reduce the progression to insulin therapy
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Does not reduce cardiovascular or renal disease independent of glycaemic control and is weight neutral
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Increase glucose-induced insulin secretion and decrease glucagon secretion by prolonging the half life of GLP-1 through inhibition of the enzyme dipeptidyl peptidase IV (DPPIV)
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Only available funded DPPIV inhibitor in NZ is Vildagliptin 50 mg tablets alone or in combination with metformin 850 mg or 1000 mg tablets
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Sitagliptin and Saxagliptin are also available but are not funded
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Maximum dose for Vildagliptin is 50 mg bd
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Maximum dose is 50 mg daily in moderate or severe renal impairment
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Adverse effects are generally mild only
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Adverse effects of DPPIV inhibitors
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Nausea, vomiting, anorexia and diarrhoea
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Nasopharyngitis
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Hepatotoxicity
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Myalgias and muscle weakness (rare)
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Skin reactions including Stevens-Johnson’s syndrome (rare)
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Measure LFTs before and 3 monthly for the first year after starting
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Consider stopping if ALT or AST > 2.5 x upper limit of normal with no other explanation
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If introduced to a regimen with insulin and/or sulfonylureas, then the dose of insulin and/or sulfonylureas may need to be reduced to prevent hypoglycaemia (particularly if the HbA1c is < 64 mmol/mol)
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Children (< 18 years), pregnancy and breastfeeding
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Severe gastrointestinal disease
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Type 1 diabetes
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ALT or AST > 2.5 x upper limit of normal
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Unstable CHF
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Patients on GLP-1 agonist therapy as DPPIV inhibitors are redundant
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Medullary thyroid carcinoma or history of MEN2 syndrome