metformin + dipyridamole

A combination of metformin, a biguanide antihyperglycemic agent used for type 2 diabetes, and dipyridamole, a phosphodiesterase inhibitor with antiplatelet properties. Metformin works by decreasing hepatic glucose production, reducing intestinal glucose absorption, and improving insulin sensitivity. It inhibits mitochondrial complex I activity, which leads to changes in AMP:ATP ratios that activate AMP-activated protein kinase (AMPK), an important regulator of glucose metabolism. Dipyridamole functions as an antiplatelet agent by inhibiting both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, which inhibits platelet function. It blocks the release of arachidonic acid from membrane phospholipids and reduces thromboxane A2 activity. Additionally, dipyridamole stimulates prostacyclin release, further inhibiting platelet aggregation. This combination is often used in patients with type 2 diabetes who have suffered cerebrovascular events.