Special Warning : אזהרת שימוש

4.4   Special warnings and precautions for use

General
GAL API FEB15 CL V11                                            2             REF SmPC 05.14 CDS 30.07.14 Galvus is not a substitute for insulin in insulin-requiring patients. Galvus 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 Galvus should be used with caution in these patients (see also sections 4.2 and 5.2).

Hepatic impairment
Galvus 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 Galvus in order to know the patient’s baseline value. Liver function should be monitored during treatment with Galvus 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 Galvus therapy is recommended.

Patients who develop jaundice or other signs suggestive of liver dysfunction should discontinue Galvus.

Following withdrawal of treatment with Galvus and LFT normalization, treatment with Galvus should not be reinitiated.

Heart Failure
A clinical trial of vildagliptin in patients with 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 CHF versus placebo Clinical experience in patients with NYHA functional class III treated with vildagliptin is still limited and results are inconclusive.
(see section 5.1 Pharmacodynamic properties).
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 (see section 5.3). Although skin lesions were not observed at an increased incidence in clinical trials, there was limited experience in patients with diabetic skin complications.
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.

Excipients
The tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.

Effects on Driving

4.7   Effects on ability to drive and use machines

No studies on the effects on the ability to drive and use machines have been performed. Patients who experience dizziness as an undesirable effect should avoid driving vehicles or using machines.