Medication Update

Disclosures

South Med J. 2002;95(1) 

In This Article

Meglitinides

Mode of Action

Meglitinides stimulate the glucose-dependent release of insulin from functioning beta cells in the pancreas.

Contraindications

Diabetic ketoacidosis. Type 1 diabetes. Hypersensitivity to the drug or inactive ingredients in the formulation. Pregnancy Category: C.

Adverse Effects

Hypoglycemia (16%-31% with repaglinide, uncommon with nateglinide), headache (11%), arthralgia (3%-6%), chest pain (3% with repaglinide), upper respiratory tract infection (10.5%-16%), cardiac ischemia (2% with repaglinide).

Drug-Drug Interactions

Azole antifungals and erythromycin may interfere with the metabolism of repaglinide, resulting in hypoglycemia. Rifampin may decrease the effectiveness of repaglinide, resulting in hyperglycemia. Calcium channel blockers, corticosteroids, estrogens, isoniazid, nicotinic acid, oral contraceptives, phenothiazines, phenytoin, sympathomimetics, thiazide diuretics, and thyroid supplements may cause hyperglycemia in combination with other antidiabetic agents, so blood glucose levels should be closely monitored when one of these drugs is added or discontinued. Monoamine oxidase inhibitors, non-selective beta blockers, NSAID's, probenecid, salicylates, and sulfonamides may cause hypoglycemia in combination with other antidiabetic agents, so blood glucose levels should be closely monitored when one of these drugs is added or discontinued.

Drug-Food Interactions

Both agents should be taken 1-30 minutes prior to meals.

Products Available

  • Nateglinide (Starlix): Starting dose, 120 mg TID, or 60 mg TID, if patient is near HbA1c goal when therapy is initiated. Usual dose range, 120 mg TID.

  • Repaglinide (Prandin): Starting dose, if HbA1c is <8%, 0.5 mg with each meal. If HbA1c is >8%, 1-2 mg with each meal. Usual dose range, 0.5-4 mg BID-QID.

Dosage Forms Available

Nateglinide: 60 mg and 120 mg tablets.

Repaglinide: 0.5 mg, 1 mg, and 2 mg tablets.

Manufacturers

Nateglinide: Novartis.

Repaglinide: Novo Nordisk.

Other Points of Interest

If patients skip meals, they should also skip their doses of nateglinide or repaglinide that they would have taken with the meals.

References

  1. Hutchison TA, Shahan DR, Anderson ML (eds): DRUGDEX System. MICROMEDEX, Inc, Englewood, Colo. (Edition expires 12/2000)

  2. Hebel SK, Katstrup EK (eds): Drug Facts and Comparisons. St. Louis, Mo. 2001

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....