BMA Concise Guide to Medicine & Drugs

Repaglinide

Brand name Prandin

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for diabetes

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Repaglinide is a drug used to treat Type 2 diabetes that cannot be adequately controlled by diet and exercise alone. It acts in a similar manner to sulphonylurea drugs by stimulating the release of insulin from the pancreas. Therefore, some of the pancreatic cells need to be functioning in order for it to be effective.

Repaglinide is quick acting, but its effects last for only about four hours. The drug is sometimes given with metformin if that drug is not providing adequate diabetic control.

Repaglinide is best taken just before a meal in order for the insulin that is released to cope with the food. If a meal is likely to be missed, the dose of repaglinide should not be taken. If a tablet has been taken and a meal is not forthcoming, some carbohydrate (as specified by your doctor or dietitian) should be eaten as soon as possible.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses 1–4 x daily (up to 30 minutes before a meal, and up to 4 meals a day). If you are going to miss a meal, do not take the tablet.

Adult dosage range 500mcg (starting dose), increased at intervals of 1–2 weeks according to response; 4–16mg daily (maintenance dose).

Onset of effect 30 minutes.

Duration of action 4 hours.

Diet advice Follow the diet advised by your doctor or dietitian.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Do not take tablets between meals. Discuss with your doctor.

Stopping the drug Do not stop taking the drug without consulting your doctor.

Exceeding the dose An overdose will cause hypoglycaemia with dizziness, sweating, trembling, confusion, and headache. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Gastrointestinal problems, such as nausea, vomiting, abdominal pain, and diarrhoea or constipation, are common at the start of treatment with replaglinide but tend to become less troublesome as treatment continues. Discuss with your doctor if such symptoms are severe or persist. Rarely, repaglinide may cause rash or itching; if so, consult your doctor.

INTERACTIONS

Clarithromycin, itraconazole, ketoconazole, monoamine oxidase inhibitors (MAOIs), trimethoprim, gemfibrozil, ACE inhibitors, salicylates, and non-steroidal anti-inflammatory drugs (NSAIDs) These drugs may enhance and/or prolong the hypoglycaemic effect of repaglinide.

Oral contraceptives, thiazide diuretics, corticosteroids, thyroid hormones, danazol, sympathomimetics, rifampicin, barbiturates, and carbamazepine These drugs may decrease the effect of repaglinide.

Beta blockers The symptoms of hypoglycaemia may be masked by these drugs, especially by non-cardioselective beta blockers (e.g. propranolol).

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems, but safety not established over 75 years.

Driving and hazardous work Avoid if low blood sugar without warning signs is likely.

Alcohol Avoid. Alcohol may upset diabetic control and may increase and prolong the effects of repaglinide.

PROLONGED USE

Repaglinide is usually prescribed indefinitely. No special problems.

Monitoring Periodic monitoring of control of blood glucose levels is necessary.