Weight-neutral, low-hypoglycaemia add-on option for type 2 diabetes — typical HbA1c reduction ~0.6–0.9%. Generally Authority Required (Streamlined) added to metformin ± sulfonylurea. Which combinations (with insulin, an SGLT-2 inhibitor) are PBS-funded differs between the four agents and has changed in recent years — confirm at pbs.gov.au before prescribing.
1Eligibility — who qualifies
✓Diagnosis — Type 2 diabetes confirmed — not PBS-listed for type 1 diabetes, LADA or gestational diabetes.
✓Inadequate control — Inadequate glycaemic response on current therapy (clinical judgement; no fixed HbA1c re-target specified).
✓Metformin trial — On metformin at maximally tolerated dose, or documented contraindication or intolerance.
✓Combination — Add to metformin alone, metformin + sulfonylurea, or sulfonylurea alone if metformin is contraindicated. Insulin/SGLT-2i combination eligibility differs by agent — confirm current rules at pbs.gov.au.
2Which gliptin
| Agent | Renal handling | Practical notes |
|---|
| Sitagliptin | Mainly renal clearance; dose down as eGFR falls | Most established; generic available |
| Vildagliptin | Renal + hepatic clearance; twice daily | Avoid in significant hepatic impairment; monitor LFTs |
| Linagliptin | Hepatobiliary clearance | No dose adjustment needed at any eGFR, including dialysis |
| Saxagliptin | Mainly renal clearance | Avoid in heart failure or at high HF risk (SAVOR-TIMI 53) |
Verify at PBS — Exact mg-per-eGFR-band dosing follows the current product information, not reproduced here. Which agents are PBS-funded in combination with insulin or an SGLT-2 inhibitor differs between the four gliptins and has changed over time — confirm the current rule for the specific agent at pbs.gov.au.
Safety
- Not for type 1 diabetes, LADA or gestational diabetes.
- Discontinue if acute pancreatitis suspected; caution with a prior pancreatitis history.
- Saxagliptin: avoid in heart failure or at high HF risk.
- Vildagliptin: avoid in significant hepatic impairment — LFTs at baseline and periodically.
Check / exclude
- Confirm which combinations (insulin, SGLT-2i, GLP-1 RA) are currently PBS-funded for the specific agent at pbs.gov.au.
- Don't combine with a GLP-1 receptor agonist — overlapping incretin pathway.
- Confirm renal function and dose-adjust (linagliptin needs none).
- Review escalation to an SGLT-2i or GLP-1 RA if HbA1c stays above target.
EN-03 v1.0 · Reviewed Jun 2026 · Review Dec 2026
For health-professional use. Eligibility and combination rules summarised from public reporting — confirm current PBS wording at pbs.gov.au. Covers sitagliptin, vildagliptin, linagliptin and saxagliptin — combination rules differ by agent; not a complete dose-and-brand matrix.
