Prandin


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Related to Prandin: repaglinide, Novonorm, Gluconorm

repaglinide

Gluconorm (CA), NovoNorm (UK), Prandin

Pharmacologic class: Meglitinide

Therapeutic class: Hypoglycemic

Pregnancy risk category C

Action

Inhibits alpha-glucosidases, enzymes that convert oligosaccharides and disaccharides to glucose. This inhibition lowers blood glucose level, especially in postprandial hyperglycemia.

Availability

Tablets: 0.5 mg, 1 mg, 2 mg

Indications and dosages

Adjunct to diet and exercise in type 2 (non-insulin-dependent) diabetes mellitus uncontrolled by diet and exercise alone, or combined with metformin in type 2 diabetes mellitus uncontrolled by diet, exercise, and either repaglinide or metformin alone

Adults: 0.5 to 4 mg P.O. before each meal; may adjust at 1-week intervals based on blood glucose response. Maximum daily dosage is 16 mg.

Contraindications

• Hypersensitivity to drug or its components
• Diabetic ketoacidosis
• Type 1 (insulin-dependent) diabetes mellitus
• Administration with gemfibrozil

Precautions

Use cautiously in:
• renal or hepatic impairment; adrenal or pituitary insufficiency; stress caused by infection, fever, trauma, or surgery
• concurrent use of CYP2C8 inhibitors (such as trimethoprim, gemfibrozil, montelukast)
• concurrent use of CYP3A4 inhibitors (such as ketoconazole, itraconazole, erythromycin)
• concurrent use of CYP3A4 or CYP2C8 inducers (such as rifampin, barbiturates, carbamazepine)
• elderly or malnourished patients
• pregnant or breastfeeding patients
• children.

Administration

• Give 15 to 30 minutes before meals. Administer two, three, or four times daily, if needed, to adapt to patient's meal pattern.

Adverse reactions

CNS: headache, paresthesia

CV: angina, chest pain

EENT: sinusitis, rhinitis

GI: nausea, vomiting, diarrhea, constipation, dyspepsia

GU: urinary tract infection

Metabolic: hyperglycemia, hypoglycemia

Musculoskeletal: joint pain, back pain

Respiratory: upper respiratory infection, bronchitis

Other: tooth disorder, hypersensitivity reaction

Interactions

Drug-drug.Barbiturates, carbamazepine, rifampin: decreased repaglinide blood level

Beta-adrenergic blockers, chloramphenicol, MAO inhibitors, nonsteroidal antiinflammatory drugs, probenecid, sulfonamides, warfarin: potentiation of repaglinide effects

Calcium channel blockers, corticosteroids, estrogens, hormonal contraceptives, isoniazid, phenothiazines, phenytoin, nicotinic acid, sympathomimetics, thyroid preparations: loss of glycemic control

Clarithromycin: increased repaglinide area under the curve and Cmax

Cyclosporine: increased repaglinide plasma concentration

Erythromycin, ketoconazole, miconazole: decreased repaglinide metabolism, increased risk of hypoglycemia

Gemfibrozil, itraconazole: significantly increased repaglinide exposure

Simvastatin: increased repaglinide level

Drug-food.Any food: decreased drug bioavailability

Drug-herbs.Aloe gel (oral), bitter melon, chromium, coenzyme Q10, fenugreek, gymnema sylvestre, psyllium, St. John's wort: additive hypoglycemic effects

Glucosamine: poor glycemic control

Patient monitoring

• Monitor blood glucose and glycosylated hemoglobin levels.
• Monitor patient's meal pattern. Consult prescriber about adjusting dosage if patient adds or misses a meal.
• Assess for angina, shortness of breath, or other discomforts.
• Watch for signs and symptoms of bronchitis and upper respiratory, urinary, and EENT infections.

Patient teaching

• Tell patient to take 15 to 30 minutes before each meal.
• Instruct patient to monitor blood glucose level carefully. Teach him to recognize signs and symptoms of hypoglycemia and hyperglycemia.
• Advise patient to report signs and symptoms of infection.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.

repaglinide

(re-pag-gli-nide) ,

Gluconorm

(trade name),

Prandin

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: meglitinides
Pregnancy Category: C

Indications

Type 2 diabetes mellitus, with diet and exercise; may be used with metformin, rosiglitazone, or pioglitazone.

Action

Stimulates the release of insulin from pancreatic beta cells by closing potassium channels, which results in the opening of calcium channels in beta cells. This is followed by release of insulin.

Therapeutic effects

Lowering of blood glucose levels.

Pharmacokinetics

Absorption: Well absorbed (56%) following oral administration.
Distribution: Unknown.
Protein Binding: >98%.
Metabolism and Excretion: Mostly metabolized by the liver; metabolites are excreted primarily in feces.
Half-life: 1 hr.

Time/action profile

ROUTEONSETPEAKDURATION
POwithin 30 min60–90 min<4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Lactation: Lactation;Diabetic ketoacidosis;Type 1 diabetes;Concurrent use of gemfibrozil.
Use Cautiously in: Impaired liver function (longer dosing intervals may be necessary);Severe renal impairment (dose ↓ recommended); Geriatric: Consider age-related ↓ in renal/hepatic/cardiovascular function; Obstetric / Pediatric: Safety not established; insulin recommended to control diabetes during pregnancy.

Adverse Reactions/Side Effects

Cardiovascular

  • angina
  • chest pain

Endocrinologic

  • hypoglycemia
  • hyperglycemia

Interactions

Drug-Drug interaction

Ketoconazole, miconazole, gemofibrozil, itraconazole, clarithromycin, and erythromycin may ↓ metabolism and ↑ risk of hypoglycemia; concurrent use with gemofibrozil contraindicated.Levels and effects may also be ↑ by NSAIDs, cyclosporine, hormonal contraceptives, simvastatin, sulfonamides, chloramphenicol, warfarin, probenecid, deferasirox, MAO inhibitors, and beta blockers.Effects may be ↓ by corticosteroids, phenothiazines, thyroid preparations, estrogens, hormonal contraceptives, phenytoin, nicotinic acid, sympathomimetics, isoniazid, and calcium channel blockers.Glucosamine may worsen blood glucose control.Chromium and coenzyme Q-10 may produce ↑ hypoglycemic effects.

Route/Dosage

Oral (Adults) 0.5–4 mg taken before meals (not to exceed 16 mg/day).

Renal Impairment

Oral (Adults) Severe renal impairment—start with 0.5 mg/day and titrate carefully.

Availability (generic available)

Tablets: 0.5 mg, 1 mg, 2 mg
In combination with: metformin (PrandiMet); see combination drugs.

Nursing implications

Nursing assessment

  • Observe patient for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety). Hypoglycemia may be difficult to recognize in geriatric patients and in patients taking beta blockers. Hypoglycemia is more likely to occur with insufficient caloric intake, following intense prolonged exercise, or when alcohol or more than 1 hypoglycemic agent is used.
  • Lab Test Considerations: Monitor fasting serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness.

Potential Nursing Diagnoses

Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Do not confuse Prandin (repaglinide) with Avandia (rosiglitazone).
  • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin. Withhold repaglinide and reinstitute after resolution of acute episode.
    • Repaglinide therapy should be temporarily discontinued for patients requiring surgery involving restricted intake of food and fluids.
    • There is no fixed dose of repaglinide. Dose is based on periodic monitoring of blood glucose and long-term response is based on glycolysated hemoglobin levels. If adequate response is not achieved, metformin may be added to regimen. If combination therapy is unsuccessful, oral hypoglycemic therapy may need to be discontinued and replaced with insulin.
    • When replacing other oral hypoglycemic agents, repaglinide may be started on the day following discontinuation of the other agent. Monitor blood glucose closely. Discontinuation of long-acting oral hypoglycemics may require monitoring for a week or more.
    • Short-term repaglinide therapy may be used for patients well controlled with diet experiencing transient loss of control.
  • Oral: Administer up to 30 min before meals. Patients who skip a meal or add an extra meal should skip or add a dose, respectively, for that meal.

Patient/Family Teaching

  • Instruct patient to take repaglinide before each meal, exactly as directed.
  • Explain to patient that repaglinide helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
  • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
  • Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
  • Instruct patient in proper testing of blood glucose. These tests should be monitored closely during periods of stress or illness and a health care professional notified if significant changes occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications and alcohol.
  • Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
  • Insulin is the recommended method of controlling blood glucose during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected.
  • Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
  • Emphasize the importance of routine follow-up exams and regular testing of blood glucose and glycosylated hemoglobin.

Evaluation/Desired Outcomes

  • Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.

Prandin

(prăn′dn)
A trademark for the drug repaglinide.

Prandin®

Repaglinide, see there.
References in periodicals archive ?
Perrigo said that the repaglinide tablets 1mg and 2mg are the generic equivalent to Prandin Tablets (repaglinide tablets) and shipment of repaglinide 1mg and 2mg tablets has commenced, adding that in 2013 it launched the 0.
Caraco Pharmaceutical Laboratories, the US subsidiary of the Indian firm Sun Pharmaceutical Industries, is seeking to produce a generic version of Prandin.
Sandoz has asked the US Food and Drug Administration (FDA) for approval of its generic formulation of Prandin, which puts the company "at considerable risk of being sued" as Novo Nordisk still has a patent on the drug, according to the complaint.
the manufacturer of repaglinide, marketed as Prandin.
That's the conclusion of a national survey, funded by Novo Nordisk Pharmaceuticals, maker of Prandin (repaglinide tablets).
The tablets are the generic equivalent of Novo Nordisk Inc s Prandin tablets and are pointed as an adjunct to diet and exercise to meliorate glycemic control in adults with type 2 diabetes mellitus.
M2 PHARMA-January 24, 2014-Mylan unveils generic Prandin Tablets
M2 EQUITYBITES-January 24, 2014-Mylan unveils generic Prandin Tablets
applying to market a generic of oral diabetes treatment Prandin and its
In the USA, Novo Nordisk markets repaglinide under the trade name Prandin and a fixed dose repaglinide/metformin tablet under the PrandiMet brand.
Generic name Trade name Mechanism of action Repaglinide Prandin [up arrow] Insulin secretion Sulfonylureas Amaryl [up arrow] Insulin secretion Glucotrol XL Glynase [alpha]-Glucosidase Precose Delays digestion and absorption of complex inhibitors Glyset carbohydrates Metformin Glucophage Insulin sensitizes (liver > muscle) Thiazolidinedione Rezulin Insulin sensitizes (Troglitazone) (muscle > liver) Effects on glycemia Generic name FPG, (a) mg/L [HbA.