Jalra (Vildagliptin)

Vildagliptin is used in the treatment of type 2 diabetes mellitus, a chronic metabolic disorder characterized by insulin resistance and impaired glucose regulation.

• Type 2 diabetes mellitus: Improves glycemic control when combined with diet, exercise and other antidiabetic agents.
• Combination with metformin: Enhances overall glucose‑lowering effect in patients requiring dual therapy.
• Use as add‑on to insulin or sulfonylureas: Provides additional reduction in HbA1c for patients not achieving targets.

• Vildagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones GLP‑1 and GIP. By blocking DPP‑4, endogenous GLP‑1 and GIP levels rise, leading to glucose‑dependent stimulation of insulin secretion and suppression of glucagon release from pancreatic α‑cells, thereby lowering post‑prandial and fasting blood glucose concentrations. The effect is glucose‑dependent, minimizing risk of hypoglycaemia when used without insulin secretagogues, and it does not affect gastric emptying or insulin sensitivity directly.

Vildagliptin may be associated with a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient cranial discomfort.
• Dizziness: occasional light‑headedness.
• Upper respiratory tract infection: symptoms such as sore throat or nasal congestion.
• Hypoglycaemia (when combined with insulin or sulfonylureas): low blood sugar episodes.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain with elevated enzymes.
• Severe allergic reactions: rash, angioedema or anaphylaxis.
• Hepatic dysfunction: abnormal liver enzymes or jaundice.
• Bullous pemphigoid: skin blistering disorder.
• Severe hypoglycaemia: prolonged low glucose requiring assistance.

When prescribing Vildagliptin, clinicians should consider several precautionary measures to ensure safe use.

• Renal impairment: assess kidney function and adjust dose if necessary.
• Hepatic impairment: use with caution and monitor liver enzymes.
• Risk of hypoglycaemia: monitor glucose closely when combined with insulin or sulfonylureas.
• Pregnancy and lactation: avoid unless benefits outweigh potential risks.
• Elderly patients: evaluate renal function regularly due to age‑related decline.
• Store at ambient temperature below 25°C: keep in the original container, protect from moisture.

Vildagliptin can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Concomitant use with insulin secretagogues (e.g., sulfonylureas): may cause severe hypoglycaemia.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): can increase vildagliptin plasma concentrations.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: monitor renal function and potassium levels.
• Diuretics: watch for electrolyte disturbances.
• Warfarin: check INR regularly for anticoagulation changes.
• Rifampin: may reduce vildagliptin effectiveness.
• Oral contraceptives: possible alteration in hormone levels, monitor efficacy.