Prandin

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 C_max

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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

Prandin

(prăn′dn)

A trademark for the drug repaglinide.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Prandin^®

Repaglinide, see there.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.