Melkart (Vildagliptin)

Melkart, a DPP‑4 inhibitor, is used in the management of disorders related to impaired glucose regulation.

• Type 2 diabetes mellitus: lowers fasting and post‑prandial blood glucose levels.
• As adjunct to diet and exercise: improves overall HbA1c when lifestyle measures are insufficient.
• In combination therapy (e.g., with metformin): provides additional glycaemic reduction for patients not reaching targets on monotherapy.

• Vildagliptin selectively inhibits the dipeptidyl peptidase‑4 (DPP‑4) enzyme, preventing the rapid degradation of endogenous incretin hormones GLP‑1 and GIP. Elevated incretin levels enhance glucose‑dependent insulin secretion from pancreatic β‑cells and suppress glucagon release from α‑cells, resulting in reduced hepatic glucose output and improved post‑prandial glucose control.

Adverse reactions may occur with any medication. Monitoring and reporting are essential.

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 (anaphylaxis): rash, swelling, difficulty breathing.
• Hepatic dysfunction: elevated liver enzymes or jaundice.
• Severe skin reactions (Stevens‑Johnson syndrome, toxic epidermal necrolysis): blistering and detachment of skin.
• Bullous pemphigoid: chronic blistering skin disease.
• Marked hypoglycaemia: especially when used with insulin secretagogues.

Before initiating therapy, consider patient‑specific factors and monitor appropriately.

• Renal impairment: dose adjustment may be required; assess creatinine clearance.
• Hepatic impairment: use with caution; monitor liver function tests.
• Not indicated for type 1 diabetes or diabetic ketoacidosis: ineffective in insulin‑deficient states.
• Concomitant sulfonylureas or insulin: increased risk of hypoglycaemia; adjust co‑medication as needed.
• Pregnancy and lactation: safety not established; avoid unless benefits outweigh risks.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture and direct sunlight.

Vildagliptin may interact with other medicines; awareness helps prevent adverse events.

Major Interactions (Avoid)

• Concurrent use with insulin or sulfonylureas: can cause severe hypoglycaemia.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase plasma levels.

Moderate Interactions (Monitor Closely)

• Rifampicin: may reduce vildagliptin exposure, diminishing efficacy.
• Beta‑blockers: can mask hypoglycaemia symptoms, requiring closer glucose monitoring.
• Diuretics (thiazides): may affect glucose tolerance, necessitating periodic assessment.