repaglinide, Prandin (cont.)

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Side effects that have been reported post-marketing inlcude:

GENERIC AVAILABLE: Yes

PRESCRIPTION: Yes

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

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

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).
  • Some drugs increase blood sugar and therefore reverse the effects of repaglinide. Such drugs include thiazide diuretics (for example, hydrochlorothiazide [Microzide]), loop diuretics (for example, furosemide [Lasix)], amphetamines, glucocorticoids such as prednisone and methylprednisolone (Medrol), estrogens, isoniazid, phenothiazines such as chlorpromazine (Thorazine), phenytoin (Dilantin), somatropin (Genotropin), decongestants and thyroid drugs.
  • Anabolic steroids or androgens can increase the risk of developing hypoglycemia in diabetic patients taking glucose-lowering medications.
  • MAO inhibitors (for example, isocarboxazid [Marplan] and phenelzine [Nardil], salicylates, and selective serotonin reuptake inhibitors (for example paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft) also can increase the effects of repaglinide and worsen the chance of developing hypoglycemia.
  • Beta blockers, for example, propranolol (Inderal), atenolol (Tenormin), can cause hypoglycemia or hyperglycemia. Also, beta-blockers can blunt some of the body's responses to hypoglycemia such as rapid heart ratea, thus making it difficult for patients to recognize (and treat) hypoglycemic reactions. Nevertheless, beta-blockers have been used successfully in diabetic patients. Treatment with beta-blockers is associated with improved survival in diabetics who are treated with the beta-blocker for high blood pressure.
  • Gemfibrozil (Lopid) should not be combined with repaglinide because gemfibrozil may increase blood levels of repaglinide and lead to hypoglycemia.
  • Atazanavir (Reyataz) and Trimethoprim (Primsol) can increase the blood levels of repaglinide as well leading to increased risks of hypoglycemia.
Medically Reviewed by a Doctor on 12/11/2014


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