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