Fixed-dose combination: DPP-4 inhibitor plus biguanide
ATC code: A10BD08 (Vildagliptin and metformin)
Vildagliptin inhibits DPP-4 and raises endogenous GLP-1 and GIP, enhancing glucose-dependent insulin secretion and suppressing glucagon. Metformin lowers hepatic gluconeogenesis, increases peripheral insulin sensitivity, and slightly reduces intestinal glucose absorption. Additive effect: about -0.7% from DPP-4 on top of metformin.
Second line
Type 2 diabetes in adults with above target (usually <7%, <7.5-8% in older patients) on metformin monotherapy. Per / 2024 and redGDPS 2024, DPP-4 + metformin is one second-line option when ASCVD, HF, or CKD is absent (otherwise GLP-1 RA or SGLT2 inhibitors take priority). Dose: 50/850, 50/1000 mg twice daily with meals. Check HbA1c at 3 months. Combination strength – weight-neutral and low hypoglycemia risk.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Metformin in fixed-dose combinations is marketed as an anti-aging drug that extends lifespan in healthy adults. In 2026 the principal TAME trial is still ongoing with no results yet. In people without diabetes or prediabetes, metformin is not approved by AEMPS, , or . Additional risks include B12 deficiency (6-30% on long-term use), lactic acidosis during dehydration, and GI side effects. If prescribed for longevity without a diagnosis of type 2 diabetes or prediabetes ( <5.7%), consider getting a second opinion.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Metformin is permitted in pregnancy for type 2 diabetes or gestational diabetes (per ADA 2024 and SEGO 2023, insulin remains first-line). Vildagliptin is not studied in pregnancy – switch to insulin.
Metformin is compatible with breastfeeding (RID 0.28-0.65%, Hale L1). No milk data for vildagliptin – in nursing women, use metformin monotherapy or insulin instead of the DPP-4 combination.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Vildagliptin + Metformin is evaluated for the following indications with varying evidence strength: Type 2 diabetes mellitus (evidence tier A), Anti-aging and longevity (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Vildagliptin + Metformin (≥ 1 in 100): Nausea, diarrhea, metallic taste (metformin), Headache, Nasopharyngitis, Dizziness, Hypoglycemia when combined with sulfonylurea or insulin. See the Safety section for uncommon and serious reactions.
FDA category B. Metformin is permitted in pregnancy for type 2 diabetes or gestational diabetes (per ADA 2024 and SEGO 2023, insulin remains first-line). Vildagliptin is not studied in pregnancy – switch to insulin.
Metformin is compatible with breastfeeding (RID 0.28-0.65%, Hale L1). No milk data for vildagliptin – in nursing women, use metformin monotherapy or insulin instead of the DPP-4 combination.
Vildagliptin + Metformin is contraindicated in: Hypersensitivity; Type 1 diabetes; Diabetic ketoacidosis; Severe hepatic impairment (ALT >3× ULN); Severe renal impairment (CrCl <30). Full list in the Safety section.