repaglinide

repaglinide /re·pag·li·nide/ (rĕ-pag´lĭ-nīd) an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus.

repaglinide,

an antidiabetic.

indication It is used to treat stable type 2 diabetes mellitus.

contraindications Known hypersensitivity to meglitinides, diabetic ketoacidosis, and type 1 diabetes mellitus prohibit its use.

adverse effects Hypoglycemia is a life-threatening effect. Other adverse effects include paresthesia, nausea, vomiting, diarrhea, constipation, dyspepsia, rash, allergic reactions, back pain, arthralgia, upper respiratory infection, sinusitis, rhinitis, and bronchitis. Headache and weakness are common side effects.

repaglinide Warning - High-alert drug!

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

Precautions

Use cautiously in:
• renal or hepatic impairment; adrenal or pituitary insufficiency; stress caused by infection, fever, trauma, or surgery
• 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.

Route	Onset	Peak	Duration
P.O.	Within 30 min	60-90 min	<4 hr

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 anti-inflammatory 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

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

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.