Nateglinide

(nah-TEG-lih-nide)

  Action:
Lowers blood glucose levels by stimulating insulin secretion from the pancreas.

  Indications:
As monotherapy to lower blood glucose in patients with type 2 diabetes mellitus (noninsulin dependent diabetes mellitus) whose hyperglycemia cannot be adequately controlled by diet and exercise and who have not been chronically treated with other antidiabetic agents; in combination with metformin, but not substituted for metformin, in patients whose hyperglycemia is not adequately controlled with metformin alone.

  Contraindications:
Type 1 diabetes; diabetic ketoacidosis.

  Route/Dosage:

Adults:
PO 120 mg tid, 1 to 30 min before meals, alone or in combination with metformin. The 60 mg dose of nateglinide may be used, alone or in combination with metformin, in patients near goal glycosylated hemoglobin when treatment is initiated.

  Interactions:

Monoamine oxidase inhibitors, nonselective beta-adrenergic blocking agents, nonsteroidal anti-inflammatory drugs, salicylates: May potentiate the hypoglycemic effects of nateglinide.

Corticosteroids, sympathomimetics, thiazide diuretics, thyroid products: May reduce the hypoglycemic effects of nateglinide.

  Lab Test Interferences:
Uric acid levels may be increased.

  Adverse Reactions:

CNS:

Dizziness.

GI:

Diarrhea.

META:

Hypoglycemia.

RESP:

Upper respiratory infection; bronchitis; coughing.

OTHER:

Back pain; flu symptoms; arthropathy; accidental trauma.

  Precautions:

Pregnancy: Category C.

Lactation: Undetermined.

Children: Safety and efficacy not established.

Hepatic impairment: Use with caution in patients with moderate-to-severe or chronic liver disease.

Secondary failure: Transient loss of glycemic control may occur in patients with fever, infection, trauma, or surgery.

Special populations: Patients with type 2 diabetes and renal failure on dialysis may exhibit reduced overall drug exposure.

  Administration/Storage:

• Administer each prescribed dose immediately before or up to 30 min before each meal.
• If a meal is skipped, skip the dose reduce the risk of hypoglycemia.
• Store at controlled room temperature. Keep tightly closed.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies. Note history of liver disease and the nature of the patient's diabetes (type 1 vs type 2).
• Check blood sugars frequently, observe for signs of hypoglycemia and hyperglycemia, and report to health care provider.

  Patient/Family Education:

• Explain name, dose, action, and potential side effects of drug.
• Instruct patient to take prescribed dose immediately before to up to 30 min before each meal.
• Instruct patient that if meal is missed, to skip the dose for that meal to reduce risk of hypoglycemia.
• Educate patient, family, or caregiver regarding type 2 diabetes and its management.
• Instruct patient that this drug is not a substitute for diet and exercise, and that patient should continue to follow prescribed regimens.
• Emphasize the importance of regular daily blood glucose monitoring and periodic glycosylated hemoglobin (HbA1c) tests.
• Advise patient to carry medical identification that they are diabetic (eg,
  Medi-Alert).
• Review symptoms of hypoglycemia and hyperglycemia and action plans to undertake in the event either occur.
• Instruct patient to notify health care provider if experiencing hypoglycemic or hyperglycemic episodes.
• Advise female patient to inform health care provider if becoming pregnant, planning on becoming pregnant, or breastfeeding.
• Instruct patient not to take prescription or otc drugs or dietary supplements without consulting health care provider.
• Advise patient that follow-up visits and lab tests will be required to monitor therapy and to be sure and keep appointments.

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