Repaglinide

Name: Repaglinide

Repaglinide Drug Class

Repaglinide is part of the drug class:

  • Other blood glucose lowering drugs, excl. insulins

Repaglinide Precautions

Serious side effects have been reported with repaglinide including:

  • loss of blood sugar control. This may result in low blood sugar episodes, high blood sugar episodes, or both.

    • Tell your healthcare provider right away if you have some or all of the following symptoms of low blood sugar:

      • hunger
      • shakiness
      • dizziness
      • confusion
      • difficulty speaking
      • feeling anxious or weak
    • Tell your healthcare provider right away if you have some or all of the following symptoms of high blood sugar:

      • coma
      • convulsions
      • confusion
      • increased thirst
      • fever
      • frequent urination
      • nausea
      • lethargy
      • weight loss
      • weakness
  • heart problems.  Tell your healthcare provider right away if you have some or all of the following symptoms of a heart problem:

    • chest pain
    • high blood pressure
    • abnormal heart beat
  • thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. Tell your healthcare provider right away if you have the following signs and symptoms of thrombocytopenia:

    • mild to serious bleeding
    • purple, brown, and red bruises (purpura)
    • small red or purple dots on your skin (petechiae)
    • prolonged bleeding, even from minor cuts
    • bleeding or oozing from the mouth or nose, especially nosebleeds or bleeding from brushing your teeth
    • abnormal vaginal bleeding (especially heavy menstrual flow)
    • blood in the urine or stool or bleeding from the rectum. Blood in the stool can appear as red blood or as a dark, tarry color. Taking iron supplements also can cause dark, tarry stools.
    • headaches and other neurological symptoms. These problems are very rare, but you should discuss them with your doctor.
  • leukopenia. This is a condition when there are a low number of white blood cells in your body. These cells help fight infections. Those who develop leukopenia are more likely to have fevers and infections.

  • elevated liver enzymes in liver function tests.

  • hypersensitivity (severe allergic reaction). Tell your healthcare provider about any signs or symptoms of hypersensitivity, which include the following:

    • chest pain
    • swelling of the face, eyes, lips, tongue, arms, or legs
    • difficulty breathing or swallowing
    • fainting
    • rash

Do not take repaglinide if you:

  • are allergic to any of its ingredients
  • have a condition called diabetic ketoacidosis
  • have type 1 diabetes
  • take a medication called gemfibrozil (Lopid)

Repaglinide Food Interactions

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of repaglinide, there are no specific foods that you must exclude from your diet when receiving this medication.

What should I avoid while taking repaglinide?

Avoid drinking alcohol. It lowers blood sugar and may interfere with your diabetes treatment.

Advice to Patients

  • Advise fully and completely about the nature of diabetes mellitus, how to prevent and detect complications, and control their condition.18 29 31 45 71

  • Importance of dietary regulation as principal consideration in management of diabetes mellitus.1 42 43 44 Advise that repaglinide therapy is used only as an adjunct to,1 and not a substitute for, proper dietary regulation.1 5 Advise that patients should not neglect dietary restrictions, develop a careless attitude about their condition, or disregard instructions about weight control, exercise, hygiene, and avoidance of infection.46 47

  • Inform patients of the potential risks and advantages of repaglinide therapy and of alternative forms of treatment.1 5

  • Importance of adherence to meal planning and dosing; if skipping a meal or adding an extra meal, skip or add a dose, respectively, for that meal.1 5 14 59 61 62 68 71

  • Advise that failure to follow an appropriate dosage regimen may result in hypoglycemia or hyperglycemia.14

  • Instruct patients on proper use of other antidiabetic agents, if concomitant therapy required, in order to avoid hypoglycemia.1 5

  • Inform patients of risks of hypoglycemia, symptoms and treatment of hypoglycemic reactions, and conditions that predispose to the development of such reactions.1 5 31

  • Instruct patients about the possibility of primary and secondary failure of oral antidiabetic agents.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Repaglinide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

0.5 mg

Prandin (with povidone)

Novo Nordisk

1 mg

Prandin (with povidone)

Novo Nordisk

2 mg

Prandin (with povidone)

Novo Nordisk

What do I need to tell my doctor BEFORE I take Repaglinide?

  • If you have an allergy to repaglinide or any other part of repaglinide.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Acidic blood problem or type 1 diabetes.
  • If you are taking gemfibrozil.
  • If you are breast-feeding or plan to breast-feed.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take repaglinide with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

Consumer Information Use and Disclaimer

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else's drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take repaglinide or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to repaglinide. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

Pharmacologic Category

  • Antidiabetic Agent, Meglitinide Analog

Contraindications

Hypersensitivity to repaglinide or any component of the formulation; concurrent gemfibrozil therapy

Canadian labeling: Additional contraindications (not in US labeling): Severe hepatic impairment; concurrent use with clopidogrel; diabetic ketoacidosis, with or without coma; type 1 diabetes (insulin dependent)

Dosing Geriatric

Refer to adult dosing.

Warnings/Precautions

Concerns related to adverse effects:

• Hypoglycemia: Severe hypoglycemia may occur; risk may be increased by changes in meal patterns, changes in physical activity levels, changes to coadministered medications, and concomitant use with other antidiabetic agents.

Disease-related concerns:

• Cardiovascular effects: Some studies suggest oral hypoglycemic drugs may be associated with increased cardiovascular events. Theoretically, repaglinide may also increase cardiovascular events, but there are no long-term studies assessing this concern. Use in combination with NPH insulin is not indicated; in two studies, reports of myocardial ischemia (6 events) in patients using repaglinide plus insulin have caused concern. Further evaluation is required to assess the safety of this combination.

• Hepatic impairment: Use with caution in patients with hepatic impairment; may be more susceptible to glucose-lowering effects.

• Renal impairment: Use with caution in patients with severe renal impairment; may be more susceptible to glucose-lowering effects.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant drug-drug interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Other warnings/precautions:

• Appropriate use: Not for use in patients with diabetic ketoacidosis or patients with type 1 diabetes mellitus (insulin-dependent).

Monitoring Parameters

Monitor fasting blood glucose (periodically) and glycosylated HbA1c levels (at least twice yearly in patients who have stable glycemic control and are meeting treatment goals; quarterly in patients not meeting treatment goals or with therapy change [ADA 2016a]). During dose adjustment, fasting glucose can be used to determine response.

Dialysis

Data not available

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