• Type 2 diabetes mellitus (as adjunct to diet and exercise).

Contraindicated in:

• Hypersensitivity
• Diabetic ketoacidosis
• Type 1 diabetes
• Concurrent use of gemfibrozil
• Lactation: Lactation.

Use Cautiously in:

• Hepatic impairment (longer dosing intervals may be necessary)
• Severe renal impairment (dose ↓ recommended)
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Pedi: Safety and effectiveness not established in children
• Geri: Consider age-related ↓ in renal/hepatic/cardiovascular function.

CV: angina, chest pain.

Endo: hypoglycemia.

Drug-Drug:

• Ketoconazole, miconazole, gemfibrozil, itraconazole, clarithromycin, and erythromycin may ↓ metabolism and ↑ risk of hypoglycemia; concurrent use with gemfibrozil contraindicated.
• Levels and effects may also be ↑ by NSAIDs, clopidogrel, cyclosporine, hormonal contraceptives, simvastatin, sulfonamides, chloramphenicol, warfarin, probenecid, deferasirox, MAO inhibitors, and beta blockers; avoid concurrent use with clopidogrel, if possible (if not possible, ↓ dose of repaglinide).
• Effects may be ↓ by corticosteroids, phenothiazines, thyroid preparations, estrogens, hormonal contraceptives, phenytoin, nicotinic acid, sympathomimetics, isoniazid, and calcium channel blockers.

Drug-Natural Products:

• Glucosamine may worsen blood glucose control.
• Chromium and coenzyme Q-10 may produce ↑ hypoglycemic effects.

(Generic available)

• Tablets: 0.5 mg; 1 mg; 2 mg;

• PO (Adults): 0.5–4 mg taken before meals (not to exceed 16 mg/day); Concurrent use with cyclosporine: Not to exceed 6 mg/day;Concurrent use with clopidogrel: Initiate at 0.5 mg taken before meals (not to exceed 4 mg/day).

Prandin

• Stimulates the release of insulin from pancreatic beta cells by closing potassium channels, which results in the opening of calcium channels in beta cells. This is followed by release of insulin.

• Lowering of blood glucose levels.

Therapeutic Classification: antidiabetics

Pharmacologic Classification: meglitinides

Absorption: Well absorbed (56%) following oral administration.

Distribution: Unknown.

Protein Binding: >98%.

Metabolism/Excretion: Mostly metabolized by the liver; metabolites are excreted primarily in feces.

Half-life: 1 hr.

Gluconorm

• Instruct patient to take repaglinide before each meal, exactly as directed.
• Explain to patient that repaglinide helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
• Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
• Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
• Instruct patient in proper testing of blood glucose. These tests should be monitored closely during periods of stress or illness and a health care professional notified if significant changes occur.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications and alcohol.
• Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
• Insulin is the recommended method of controlling blood glucose during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected and to avoid breastfeeding; may cause infant hypoglycemia.
• Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
• Emphasize the importance of routine follow-up exams and regular testing of blood glucose and glycosylated hemoglobin.

re-PAG-gli-nide