Icandra (Metformin Hydrochloride, Vildagliptin)

Icandra, a combination of metformin and vildagliptin, is used in the management of type 2 diabetes mellitus, targeting both hepatic glucose production and incretin‑mediated insulin secretion.

• Type 2 diabetes mellitus: improves glycaemic control when combined with diet and exercise.
• Adjunct to lifestyle therapy: enhances the effectiveness of diet, exercise and weight‑management programs.
• Combination therapy: provides a single‑tablet option for patients already on metformin who need additional glucose lowering.

• Metformin reduces hepatic gluconeogenesis and increases peripheral insulin sensitivity, while vildagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), leading to increased levels of endogenous incretin hormones (GLP‑1 and GIP). The elevated incretins enhance glucose‑dependent insulin secretion and suppress glucagon release, together providing complementary glucose‑lowering effects. This dual mechanism addresses both fasting and post‑prandial hyperglycaemia, supporting overall HbA1c reduction when used with lifestyle measures.

Icandra may cause adverse reactions; reported events are grouped by frequency.

Common Side Effects

• Nausea: mild to moderate stomach upset, often transient.
• Diarrhoea: loose stools that usually improve with continued therapy.
• Abdominal discomfort: cramping or pain in the stomach area.
• Headache: mild tension‑type headache.

Serious or Rare Side Effects

• Lactic acidosis: rare but life‑threatening metabolic disturbance.
• Severe hypoglycaemia: especially when combined with insulin or sulfonylureas.
• Pancreatitis: acute inflammation of the pancreas presenting with abdominal pain.
• Severe skin reactions: such as Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatic dysfunction: abnormal liver enzymes or liver injury.

When prescribing Icandra, clinicians should consider several safety factors.

• Renal function assessment: evaluate kidney function before initiating and monitor periodically.
• Lactic acidosis risk: avoid use in patients with severe renal impairment or conditions predisposing to hypoxia.
• Hypoglycaemia risk: monitor blood glucose closely when combined with insulin or sulfonylureas.
• Pregnancy and lactation: use only if the potential benefit outweighs the potential risk.
• Drug interactions: review concomitant medications for possible DPP‑4 inhibitor interactions.
• Store at ambient temperature: keep below 25 °C, retain in the original pack, and protect from moisture.

Icandra can interact with other medicines; interactions are classified by clinical significance.

Major Interactions (Avoid)

• Concomitant use with other biguanides: increases risk of lactic acidosis.
• Severe renal impairment: markedly raises metformin exposure and lactic acidosis risk.
• Strong CYP450 inhibitors: may elevate vildagliptin plasma levels.

Moderate Interactions (Monitor Closely)

• Sulfonylureas or insulin: heightened risk of hypoglycaemia; adjust dose as needed.
• Diuretics: may affect renal clearance of metformin, requiring dose adjustment.
• Iodinated contrast media: temporary discontinuation of metformin is recommended to prevent renal dysfunction.