Melkart (Vildagliptin)

Melkart (vildagliptin) is used in the management of type 2 diabetes, a chronic metabolic disorder that affects glucose regulation.

• Type 2 diabetes mellitus: improves glycaemic control by increasing insulin secretion and reducing glucagon release.
• Adjunct to diet and exercise: provides additional glucose‑lowering effect when lifestyle measures are inadequate.
• Combination therapy: can be co‑prescribed with metformin, sulfonylureas or insulin to achieve target HbA1c levels.

• Vildagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the degradation of endogenous incretin hormones (GLP‑1 and GIP). Higher incretin levels enhance glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, leading to reduced post‑prandial glucose excursions and overall improved glycaemic control.

Vildagliptin is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient cranial discomfort.
• Dizziness: occasional light‑headedness.
• Upper respiratory tract infection: mild cold‑like symptoms.
• Diarrhoea: loose stools, usually self‑limiting.
• Hypoglycaemia (when combined with insulin or sulfonylureas): low blood sugar episodes.

Serious or Rare Side Effects

• Pancreatitis: severe abdominal pain requiring immediate medical attention.
• Severe allergic reactions: rash, swelling, or anaphylaxis.
• Hepatic injury: elevated liver enzymes or jaundice.
• Bullous skin disorders: blistering skin conditions such as Stevens‑Johnson syndrome.
• Acute renal failure: sudden decline in kidney function.
• Cardiovascular events: rare reports of heart failure exacerbation.

Before initiating therapy with vildagliptin, several safety considerations should be reviewed.

• Renal function monitoring: adjust use in patients with impaired kidney function.
• Hepatic impairment: evaluate liver enzymes and use cautiously.
• Concomitant insulin or sulfonylureas: monitor for hypoglycaemia and adjust doses.
• History of pancreatitis: avoid or use only after careful risk‑benefit assessment.
• Hypersensitivity: discontinue if allergic reactions develop.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Insulin: increased risk of severe hypoglycaemia.
• Sulfonylureas (e.g., glipizide): heightened hypoglycaemia potential.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may raise vildagliptin plasma levels.

Moderate Interactions (Monitor Closely)

• Rifampin: may reduce vildagliptin exposure, decreasing effectiveness.
• Digoxin: potential increase in digoxin concentrations.
• Warfarin: monitor INR as anticoagulant effect could be altered.