Adult Dosing
Type II diabetes mellitus (NIDDM)
- Patients previously not treated or with HbA1c <8%: Start 0.5 mg PO with each meal
- Patients previously treated with glucose-lowering drugs and with HbA1c
8%: Start 1-2 mg with each meal - Usual dose range: 0.5-4 mg
- Double the preprandial dose up to 4 mg with each meal until satisfactory response is achieved; there should be a gap of at least 7 days to assess response after each dose adjustment
- Max: 16 mg/day
Notes:- Doses should be taken from immediately preceding the meal to 30 mins before the meal
- Change the dosage frequency preprandially to 2, 3, or 4 times a day in response to changes in the patient’s meal pattern
- Monitor the patients closely for 1 wk or longer when transferring from longer half-life sulfonylurea agents (e.g., chlorpropamide) to repaglinide
- Metformin or thiazolidinedione may be added when repaglinide does not result in adequate glycemic control with the same starting dose and dose adjustments for combination therapy as for repaglinide monotherapy
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Mild-moderate impairment (40-80 mL/min): No dose adjustments
- Severe impairment (20-40 mL/min): Start 0.5 mg PO before each meal; titrate with caution
- <20 mL/min: Dose adjustments not defined, caution advised
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined, caution advised; wait longer intervals between dose adjustments to fully assess response
See Supplemental Patient Information
- Repaglinide is not recommended for use in combination with NPH-insulin
- There is no conclusive evidence of macrovascular risk reduction with repaglinide therapy
- Repaglinide may produce severe hypoglycemia; thus, proper patient selection, dosage, and instructions are important to avoid hypoglycemic episodes
- The elderly, debilitated, or malnourished patients, and those with adrenal, pituitary, hepatic or severe renal insufficiency may be more susceptible to the hypoglycemic action of repaglinide
- It may be difficult to recognize the hypoglycemia in elderly and in people taking beta-adrenergic blocking drugs
- Incidence of hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, with alcohol intake, or when more than one glucose-lowering drug is used
- Patients who have not been treated with oral anti-diabetic agents before or with HbA1c <8% may experience hypoglycemic episodes more frequently
- Patients stabilized on any diabetic regimen may experience a loss of glycemic control when exposed to stress including trauma, fever, infection, or surgery. At such times, it may be necessary to discontinue repaglinide and administer insulin
- Periodically monitor fasting blood glucose to determine minimum effective dose for the patient and to detect primary and secondary failure; monitor glycosylated hemoglobin levels (A1c), every 3-6 months, to evaluate patient's long-term response to therapy
Cautions: Use cautiously in
- Severe renal disease
- Hepatic impairment
- Insulin use
Supplemental Patient Information
- Instruct patients who skip a meal (or add an extra meal) to skip (or add) a dose for that meal
- Inform patients about the importance of adherence to dietary instructions, regular exercise program, and of regular blood glucose and HbA1c testing
Pregnancy Category:C
Breastfeeding: Because no information is available on the use of repaglinide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitoring the infant's blood glucose is advisable during maternal therapy with hypoglycemic agents. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 8 April 2011). According to the manufacturer's data, because there exists a potential for hypoglycemia in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug taking into account the importance of the drug to the mother. Insulin therapy should be considered if repaglinide is discontinued and if response to diet is inadequate.
Pricing data from www.DrugStore.com in U.S.A.
- Prandin 0.5 MG TABS [Bottle] (NOVO NORDISK)
30 mg = $91.21
90 mg = $263.72 - Prandin 2 MG TABS [Bottle] (NOVO NORDISK)
90 mg = $263.75
270 mg = $759.36 - Prandin 1 MG TABS [Bottle] (NOVO NORDISK)
30 mg = $91.21
90 mg = $263.72
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
