Medications and Drugs

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GENERIC NAME: nateglinide

BRAND NAME: Starlix

DRUG CLASS AND MECHANISM: Nateglinide is an oral drug used to lower blood sugar (glucose) levels in type 2 diabetes. It is in a class of drugs called meglitinides which also includes repaglinide (Prandin). Approximately 90% of patients with diabetes have type 2 diabetes. Type 2 diabetes usually occurs in adults and is associated with obesity and a strong family history of diabetes. Insulin is an important hormone that controls the blood level of glucose. Type 2 diabetics have an inability to control blood glucose levels. This is caused by reduced secretion of insulin from the pancreas after meals and resistance of the body's cells to the effect of insulin which is to stimulate the cells to remove glucose from the blood. This leads to high levels of blood glucose. Nateglinide stimulates cells in the pancreas to produce insulin in a manner similar to the class of drugs called sulfonylureas, e.g., glyburide (Diabeta, Glynase and Micronase) which also are used in type 2 diabetes. However, nateglinide appears to have a faster onset and a shorter duration of action than sulfonylureas. The benefit of this faster, shorter effect may be to prevent the rapid, transient rise in blood glucose that occurs in diabetics immediately following a meal. Nateglinide was approved by the FDA in December 2000.

GENERIC: Yes

PRESCRIPTION: yes

PREPARATIONS: Tablet: 60 and 120 mg.

STORAGE: Nateglinide should be stored at room temperature, 15-30 C (59-86 F) in an air-tight container.

PRESCRIBED FOR: Nateglinide is used to control blood glucose levels in type 2 diabetes. It may be used with diet and exercise when diet and exercise alone are not successful in controlling blood glucose. It also may be used with metformin (Glucophage), another drug that is used for controlling blood glucose in type 2 diabetes. Nateglinide is not recommended if blood glucose levels have not been controlled by a sulfonylurea since nateglinide and sulfonylureas have a similar mechanism of action. Therefore, if sulfonylureas are ineffective, it is likely that nateglinide also will be ineffective.

DOSING: Nateglinide may be prescribed at 60 or 120 mg three times daily. The dose is adjusted depending upon blood glucose and HbA1c levels. Nateglinide should be taken 30 minutes or less before a meal but should not be taken if a meal is skipped.

DRUG INTERACTIONS: Starting or stopping the following drugs may increase the response to nateglinide and may require the dose of nateglinide to be lowered: non-steroidal anti-inflammatory agents (NSAIDs) like ibuprofen (Motrin, etc.), aspirin and aspirin-like compounds, monoamine oxidase inhibitors like phenelzine (Nadril), and beta-blocking drugs like propranolol (Inderal). Starting or stopping the following drugs may decrease the response to nateglinide and may require the dose of nateglinide to be increased: thiazide diuretics like hydrochlorothiazide, steroids such as prednisone, thyroid hormone like levothyroxine, and drugs used in emergencies to regulate the heartbeat or restore breathing when airways are blocked. Examples of these latter drugs are epinephrine and albuterol (Ventolin).

PREGNANCY: No safety and efficacy studies have been conducted in pregnant women taking nateglinide.

NURSING MOTHERS: No safety and efficacy studies have been conducted in pregnant women taking nateglinide.

SIDE EFFECTS: Development of a runny nose, cough, and flu-like symptoms is the most common side effect seen with nateglinide therapy. Hypoglycemia (low blood glucose levels with or without symptoms), dizziness and joint pain may occur.

Reference: FDA Prescribing Information