Repaglinide
PRANDIN
What it isMeglitinide closing the beta-cell KATP channel; postprandial hyperglycemia in type 2 diabetes.
Why this oneMeal-linked dosing can be omitted with a skipped meal, reducing prolonged hypoglycemia compared with sulfonylureas.
What limits itFrequent meal-time dosing burdens adherence. Gemfibrozil is contraindicated because CYP2C8 inhibition can cause severe hypoglycemia.
FDA-approved for
- type 2 diabetes (1997)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 2 diabetes | Adults, HbA1c <8% | 0.5 mg before each meal | 0.5-4 mg before meals | 16 mg/day |
| Type 2 diabetes | Adults, HbA1c >=8% | 1-2 mg before each meal | 0.5-4 mg before meals | 16 mg/day |
Titration At least 1 week between dose adjustments
Renal Severe impairment (CrCl 20-40): start 0.5 mg before each meal; CrCl <20/dialysis not studied
Hepatic Use caution; longer intervals between dose adjustments; higher hypoglycemia risk
Dose before each meal (2-4x daily)
Instructions
- Take within 30 min before meals
- Skip the dose if a meal is skipped; add a dose if a meal is added
- Reduce dose if hypoglycemia occurs
Contraindications
- Concomitant use of gemfibrozil
Cautions
- Hypoglycemia (can be severe/life-threatening)
- Serious cardiovascular reactions with concomitant NPH-insulin (not indicated in combination)
- No conclusive macrovascular risk reduction
Adverse reactions
- Hypoglycemia
- Upper respiratory infection
- Headache
- Sinusitis
- Arthralgia
- Nausea
- Diarrhea
- Back pain
Pregnancy Limited data show no clear drug-associated risk; poorly controlled diabetes carries risk
Lactation Not recommended when breastfeeding
NO BOXED WARNINGS
Principal riskHypoglycemia; contraindicated with gemfibrozil
Cost, est. cash$5–$150/month
Generic entry2013
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.
Mechanism of action: Repaglinide ballicule
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Memory aids: mascots and interaction avatars
sugar → insulin secretagogue
