REPAGLINIDE

REPAGLINIDe

(rep-a-gli'nide)

Prandin, GlucoNorm

Classifications: hormone; antidiabetic agent; meglitinide;
Therapeutic: antidiabetic
Pregnancy Category: C

Availability

0.5 mg, 1 mg, 2 mg tablets

Action

Oral hypoglycemic agent that lowers blood glucose levels by stimulating release of insulin from the pancreatic islets.

Therapeutic Effect

Significantly reduces postprandial blood glucose in type 2 diabetes [preprandial blood glucose between 80 and 120 mg/dL and HbA_1C (glycosylated Hgb <6.5%)]. Minimal effects on fasting blood glucose were observed.

Uses

Adjunct to diet and exercise in type 2 diabetes. May also be used in combination with metformin.

Contraindications

Hypersensitivity to repaglinide; insulin-dependent diabetes, diabetic ketoacidosis, hypoglycemia; severe renal dysfunction; pregnancy (category C), lactation.

Cautious Use

Hypoglycemia; loss of glycemic control due to secondary failure; hepatic impairment; older adults, surgery, fever, systemic infection, trauma. No studies have been done in children.

Route & Dosage

Type 2 Diabetes
Adult: PO Initial dose: 0.5 mg 15–30 min a.c.; initial dose for patients previously using glucose-lowering agents: 1–2 mg 15–30 min a.c. (2–4 doses/d depending on meal pattern; max: 16 mg/d); dosage range: 0.5–4 mg 15–30 min a.c.

Administration

Oral

Give within 30 min of beginning a meal.
Store at 15°–30° C (59°–86° F) in a tightly closed container and protect from moisture.

Adverse Effects (≥1%)

Body as a Whole: Arthralgia, back pain, paresthesia, allergy. CNS: Headache. CV: Chest pain, angina. GI: Nausea, diarrhea, constipation, vomiting, dyspepsia. Respiratory: URI, sinusitis, rhinitis, bronchitis. Metabolic: Hypoglycemia.

Interactions

Drug: Erythromycin, ketoconazole may inhibit metabolism and potentiate hypoglycemia; barbiturates, carbamazepine, rifabutin, rifampin, rifapentine, pioglitazone may induce metabolism and cause hyperglycemia; gemfibrozil may increase risk of hypoglycemia and duration of action. Herbal: Ginseng, garlic may increase hypoglycemic effects. Food: Grapefruit juice (>1 qt/d) may increase plasma concentrations and adverse effects.

Pharmacokinetics

Absorption: Rapidly from GI tract, 56% bioavailability. Peak: 1 h. Distribution: 98% protein bound. Metabolism: In liver (CYP3A4). Elimination: 90% in feces. Half-Life: 1 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Frequent FBS and postprandial blood glucose monitoring and HbA_1C q3mo to determine effective dose.
Monitor carefully for S&S of hypoglycemia especially during the 1-wk period following transfer from a longer-acting sulfonylurea such as chlorpropamide.

Patient & Family Education

Take only with meals to lessen the chance of hypoglycemia. If a meal is skipped, skip a dose; if a meal is added, add a dose.
Start repaglinide the morning after the other agent is stopped when changing from another oral hypoglycemia drug.
Be alert for S&S of hyperglycemia or hypoglycemia (see Appendix F); report poor blood glucose control 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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