NATEGLINIDE

NATEGLINIDE
(nat-e'gli-nide)
Starlix
Classifications: hormone; antidiabetic; meglitinide;
Therapeutic: antidiabetic
; meglitinide
Prototype: Repaglinide
Pregnancy Category: C

Availability

60 mg, 120 mg tablets

Action

Lowers blood glucose levels by stimulating the release of insulin from the pancreatic cells of a type 2 diabetic. Significantly reduces postprandial blood glucose in type 2 diabetics and improves glycemic control when given before meals. There is minimal risk of hypoglycemia.

Therapeutic Effect

Effectiveness is indicated by preprandial blood glucose between 80 and 120 mg/dL and HbA1C ≤6.5%.

Uses

Alone or in combination with metformin for the treatment of non-insulin-dependent diabetes mellitus.

Contraindications

Prior hypersensitivity to nateglinide. Type 1 (insulin-dependent) diabetes mellitus, diabetic ketoacidosis; hypoglycemia; pregnancy (category C).

Cautious Use

Renal impairment; liver dysfunction; adrenal or pituitary insufficiency; malnutrition; infection, trauma, surgery or unusual stress; concurrent therapy of drugs which inhibit cytochrome P450-3A4 (e.g., erythromycin, ketoconazole); concurrent therapy with drugs which are inducers of cytochrome P450-3A4 (e.g., rifampin); other medications, especially beta-adrenergic blocking agents; surgery; trauma; lactation.

Route & Dosage

Diabetes Mellitus
Adult: PO 60–120 mg t.i.d. 1–30 min prior to meals

Administration

Oral
  • Give, preferably, 10 min before meals. Omit the dose if the meal is skipped. Add a dose if an extra meal is eaten. Never double the dose.
  • Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Back pain, flu-like symptoms. CV: Dizziness. GI: Diarrhea. Metabolic: Hypoglycemia. Musculoskeletal: Arthropathy. Respiratory: Upper respiratory infection, bronchitis, cough.

Interactions

Drug: nsaids, salicylates, mao inhibitors, beta-adrenergic blockers, may potentiate hypoglycemic effects; thiazide diuretics, corticosteroids, thyroid preparations, sympathomimetic agents may attenuate hypoglycemic effects. Herbal: Garlic, ginseng may potentiate hypoglycemic effects.

Pharmacokinetics

Absorption: Rapidly absorbed, 73% bioavailability. Peak: 1 h. Distribution: 98% protein bound. Metabolism: In liver by CYP2C9 (70%) and CYP3A4 (30%). Elimination: Primarily in urine. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Frequent FBS monitoring and HbA1C q3mo to determine effective dose.
  • Monitor carefully for S&S of hypoglycemia especially during the one-week period following transfer from a longer acting sulfonylurea such as chlorpropamide.

Patient & Family Education

  • Take only before a meal to lessen the chance of hypoglycemia.
  • When transferred to nateglinide from another oral hypoglycemia drug, start nateglinide the morning after the other agent is stopped, unless directed otherwise by physician.
  • Watch for S&S of hyperglycemia or hypoglycemia (see Appendix F); report poor blood glucose control to physician.
  • Report gastric upset or other bothersome GI symptoms to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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