Melkart (Vildagliptin)

Vildagliptin is a DPP‑4 inhibitor used in the treatment of type 2 diabetes mellitus.

• Type 2 diabetes mellitus: improves overall blood glucose control and reduces HbA1c levels.
• Combination with metformin: enhances glycaemic response when metformin alone is insufficient.
• Use with other oral antidiabetics: provides additional glucose‑lowering effect as part of multi‑drug regimens.

• Vildagliptin selectively inhibits the enzyme dipeptidyl peptidase‑4 (DPP‑4), which degrades the incretin hormones glucagon‑like peptide‑1 (GLP‑1) and glucose‑dependent insulinotropic polypeptide (GIP). By preventing this degradation, endogenous GLP‑1 and GIP levels rise, enhancing glucose‑dependent insulin secretion from pancreatic β‑cells and suppressing glucagon release from α‑cells, thereby lowering post‑prandial and fasting plasma glucose. The effect is glucose‑dependent, minimizing risk of hypoglycaemia when used without sulfonylureas.

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

Common Side Effects

• Nasopharyngitis: mild inflammation of the nose and throat.
• Headache: transient head pain.
• Dizziness: sensation of light‑headedness.
• Upper respiratory tract infection: symptoms such as cough and sore throat.
• Gastrointestinal discomfort: includes nausea, abdominal pain or dyspepsia.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain possibly indicating pancreatic inflammation.
• Severe allergic reactions: including rash, angioedema or anaphylaxis.
• Hepatic dysfunction: elevated liver enzymes or jaundice.
• Severe hypoglycaemia: low blood glucose when used with insulin or sulfonylureas.

When prescribing Vildagliptin, clinicians should consider several precautionary measures to ensure patient safety.

• Renal impairment: dose adjustment may be required in patients with reduced kidney function.
• Hepatic disease: use with caution in patients with liver dysfunction.
• Cardiovascular risk: monitor patients with a history of heart failure.
• Concomitant hypoglycaemic agents: avoid or adjust dose of insulin or sulfonylureas to reduce hypoglycaemia risk.
• Pregnancy and lactation: use only if clearly needed after evaluating benefits and risks.
• Store at ambient temperature: keep below 25 °C, retain in original packaging and protect from moisture.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors: may increase Vildagliptin plasma levels.
• Insulin or sulfonylureas: combined use can cause severe hypoglycaemia.

Moderate Interactions (Monitor Closely)

• Diuretics: may affect renal clearance of Vildagliptin.
• Rifampin: may reduce Vildagliptin effectiveness by inducing metabolism.
• Antihypertensive agents: monitor blood pressure as glucose control changes.
• Anticoagulants: observe for any unexpected bleeding changes.