Vildagliptin, a dipeptidyl peptidase-4 inhibitor, for the treatment of type 2 diabetes.

INTRODUCTION Vildagliptin is a dipeptidyl peptidase-4 inhibitor targeting the incretin system to improve glycemic control in type 2 diabetes. AREAS COVERED This review focuses on the pharmacokinetics, drug interactions and use of oral vildagliptin in special populations. Clinical efficacy and vildagliptin's role in the spectrum of therapeutics available are briefly addressed. EXPERT OPINION Vildagliptin is an effective and well-tolerated oral dipeptidyl peptidase-4 inhibitor. It is dosed orally and can be used safely as monotherapy or in combination with other oral anti-hyperglycemic agents and insulin. It is rapidly absorbed and can be taken without regard to food. It is metabolized by hydrolysis and renally cleared. It has low potential for drug interactions and is well tolerated in elderly patients. Body mass index and gender have no significant pharmacokinetic impact. There is no significant interaction with CYP enzymes. There is a low risk for hypoglycemia and weight gain. Dose adjustment is recommended for renal impairment. Prescribing vildagliptin in the setting of liver dysfunction is not recommended, although pharmacokinetics is minimally (if at all) affected. A variety of patients with type 2 diabetes may benefit from treatment with vildagliptin. Therapy should be individualized but the paucity of data in populations with advanced renal failure and hepatic dysfunction may limit the use in these patients.