repaglinide, Prandin (cont.)

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PREPARATIONS: Tablets: 0.5, 1, and 2 mg.

STORAGE: Tablets should be stored at room temperature below 25 C (77 F).

PRESCRIBED FOR: Repaglinide is used for treating type 2 diabetes in conjunction with diet and exercise. It can be used alone (monotherapy) or combined with metformin (Glucophage), pioglitazone (Actos), or rosiglitazone (Avandia).

DOSING: Repaglinide is taken 15 to 30 minutes before a meal. It should be taken with meals and may be administered 2, 3, or 4 times a day.

For patients with HbA1c < 8% who are receiving treatment for the first time the starting dose is 0.5 mg with each meal.

Patients who have been treated with other diabetes drugs and whose HbA1c is ≥ 8% should start with 1 or 2 mg with each meal. The initial dose may be doubled at weekly intervals until the desired response is achieved or the maximum dose of 4 mg with each meal (16 mg daily) is achieved.

DRUG INTERACTIONS: Repaglinide is metabolized (eliminated) in the liver by an enzyme called CYP3A4. Drugs that affect this enzyme may affect the blood levels of repaglinide and thus alter its glucose lowering effect. The metabolism of repaglinide may be prevented by ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan), erythromycin (Ery-Tab), and clarithromycin (Biaxin). As a result, blood levels of repaglinide rise and there is an enhanced glucose-lowering effect. Dangerous hypoglycemic (very low blood glucose) reactions could occur. On the other hand, the elimination of repaglinide may be increased with drugs that increase levels of CYP3A4 in the liver, such as barbiturates, carbamazepine (Tegretol), and rifampin (Rifadin). This can result in lower blood levels of repaglinide and hyperglycemia (high blood glucose).

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