Melkart Duo (Metformin Hydrochloride, Vildagliptin)

• Melkart Duo is an oral antidiabetic combination used to improve glycaemic control in type 2 diabetes.
• Type 2 diabetes mellitus: lowers fasting and post‑prandial glucose levels when diet and exercise alone are insufficient.
• Adjunct to insulin therapy: provides additional glucose‑lowering effect in patients requiring insulin.
• Combination with lifestyle measures: supports weight management and insulin sensitivity as part of a comprehensive treatment plan.

• Metformin reduces hepatic gluconeogenesis and enhances peripheral insulin sensitivity, while Vildagliptin blocks dipeptidyl peptidase‑4, increasing endogenous incretin concentrations and promoting glucose‑dependent insulin secretion. Together they provide complementary actions that lower blood glucose without causing hypoglycaemia when used alone.

Common Side Effects

• Gastrointestinal upset (nausea, diarrhoea, abdominal discomfort)
• Headache or dizziness
• Mild hypoglycaemia, especially when combined with other glucose‑lowering agents
• Metallic taste or loss of appetite
• Upper respiratory tract infection symptoms

Serious or Rare Side Effects

• Lactic acidosis (metformin‑related)
• Severe hypersensitivity reactions, including angio‑edema or Stevens‑Johnson syndrome
• Acute pancreatitis (vildagliptin‑related)
• Hepatic dysfunction or failure

• Before initiating therapy, evaluate renal and hepatic function and consider patient‑specific risk factors.
• Renal function: assess eGFR and avoid use in severe renal impairment.
• Lactic acidosis risk: contraindicated in patients with significant renal or hepatic disease.
• Hypoglycaemia risk: monitor closely when combined with insulin or sulfonylureas.
• Pregnancy and lactation: use only if potential benefit justifies potential risk.
• Alcohol consumption: limit intake to reduce risk of lactic acidosis.
• Store at ambient temperature: keep in the original pack, protect from moisture and heat.

Metformin and Vildagliptin may interact with several medicines that affect glucose control or renal clearance.

Major Interactions (Avoid)

• Concomitant use of iodinated contrast agents in patients with reduced renal function.
• Co‑administration with other biguanides (e.g., phenformin) – increased lactic acidosis risk.
• Strong CYP2C9 inhibitors (e.g., fluconazole) that raise vildagliptin plasma levels.

Moderate Interactions (Monitor Closely)

• Sulfonylureas – heightened hypoglycaemia potential.
• Insulin – additive glucose‑lowering effect.
• Diuretics – may reduce metformin renal clearance.
• Corticosteroids – may increase blood glucose, requiring dose adjustment.