Melkart (Vildagliptin)

Melkart (vildagliptin) is used in the management of type 2 diabetes, a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion.

• Type 2 diabetes mellitus: improves glycemic control by lowering fasting and post‑prandial glucose levels.
• Combination therapy with metformin: enhances overall glucose reduction when used together.
• Adjunct to diet and exercise: supports blood sugar management in patients who have not achieved targets with lifestyle measures alone.

• Vildagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones GLP‑1 and GIP. By blocking DPP‑4, vildagliptin increases endogenous incretin levels, leading to glucose‑dependent stimulation of insulin secretion, suppression of glucagon release, and delayed gastric emptying, thereby improving post‑prandial and overall glycemic control.

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.
• Upper respiratory tract infection: symptoms such as cough or sore throat.
• Dizziness: occasional light‑headed feeling.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Bullous pemphigoid: rare skin blistering disorder.

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

• Renal impairment: assess kidney function and adjust dose or avoid use in severe impairment.
• Hepatic impairment: monitor liver enzymes and use with caution in moderate liver disease.
• Elderly patients: start at the lowest effective dose and monitor for hypoglycemia.
• Concomitant sulfonylureas or insulin: increased risk of hypoglycemia; adjust co‑medication as needed.
• Pregnancy and lactation: safety not established; avoid unless benefit outweighs risk.
• Store at ambient temperature: keep below 25 °C in the original packaging, protect from moisture and light.

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

Major Interactions (Avoid)

• Insulin or sulfonylureas: may cause severe hypoglycemia when combined.
• Drugs that cause pancreatitis (e.g., azathioprine, didanosine): increase risk of pancreatic inflammation.

Moderate Interactions (Monitor Closely)

• Rifampin: may reduce vildagliptin plasma concentrations, decreasing effectiveness.
• Diuretics (thiazides): can affect glucose homeostasis, requiring closer glycemic monitoring.
• ACE inhibitors or ARBs: monitor renal function and electrolytes when used together.