nateglinide, Starlix

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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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, for example, 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 C to 30 C (59 F to 86 F), in an air-tight container.

PRESCRIBED FOR: Nateglinide is used with diet and exercise to control blood glucose levels in patients with type 2 diabetes. It also may be combined with metformin (Glucophage) or thiazolidinediones (pioglitazone [Actos] or rosiglitazone [Avandia]), which are other drugs that are used for controlling blood glucose in type 2 diabetes.

DOSING: The recommended dose of nateglinide alone or in combination with metformin or thiazolidinediones is 120 mg three times daily with meals. The 60 mg dose is used for patients who are close to their goal HbA1c when treatment is started. 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: nonsteroidal anti-inflammatory agents (NSAIDs) like ibuprofen (Motrin, etc.), aspirin and aspirin-like compounds, monoamine oxidase inhibitors like phenelzine (Nardil), 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 such as 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. Nateglinide should not be used during pregnancy.

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