Repaglinide

(reh-PAG-lih-nide)

  Action:
Decreases blood glucose by stimulating insulin release from the pancreas.

  Indications:
Adjunct to diet and exercise to lower blood glucose in patients with non-insulin dependent diabetes mellitus (type 2) whose hyperglycemia cannot be controlled by diet and exercise alone. Can be used with metformin when hyperglycemia cannot be controlled by exercise, diet and either repaglinide or metformin alone.

  Contraindications:
Insulin-dependent (type 1) diabetes; diabetic ketoacidosis with or without coma; hypersensitivity to repaglinide or its ingredients.

  Route/Dosage:
No fixed dosage regimen; periodically monitor blood glucose to determine minimum effective dose.

Patients not previously treated or whose HbA1_c is < 8%

Adults:
PO Initial dose 0.5 mg with each meal.

Patients previously treated or whose HbA1_c is > 8%

Adults:
PO Initial dose 1 to 2 mg with each meal.

  Interactions:

Barbiturates, carbamazepine, rifampin, troglitazone: May increase repaglinide metabolism.

Erythromycin, ketoconazole, miconazole: May inhibit repaglinide metabolism.

Protein bound drugs (eg, NSAIDs, salicylates, sulfonamides, probenecid, MAO inhibitors, beta-adrenergic blocking agents): May potentiate hypoglycemic effect of repaglinide.

  Lab Test Interferences:
None well documented.

  Adverse Reactions:

GI:

Nausea; vomiting; diarrhea; constipation; dyspepsia.

META:

Hypoglycemia; hyperglycemia.

RESP:

Upper respiratory tract infection; sinusitis; rhinitis; bronchitis.

OTHER:

Arthralgia; back pain; chest pain; headache; paresthesia; urinary tract infection; tooth disorder.

  Precautions:

Pregnancy: Category C. Insulin is recommended to maintain blood glucose levels during pregnancy.

Lactation: Undetermined.

Children: Safety and efficacy not established.

Elderly and debilitated patients: Elderly and debilitated patients are particularly susceptible to the hypoglycemic action of repaglinide. Hypoglycemia may be difficult to recognize in the elderly. Administer with meals to lessen risk of hypoglycemia.

Renal function impairment: Use caution when titrating repaglinide.

Hepatic function impairment: Use with caution. Allow longer intervals between dosage adjustments.

  Administration/Storage:

• Administer before meals. Can be taken immediately before or up to 30 mins before each meal.
• Hold dose if meal is missed.
• Add dose if meal is added.
• Dosage increases should occur no more frequently than weekly.
• Usual dose is 0.5 to 4 mg with each meal. Maximum daily dose is 16 mg/day.
• Store in a tightly capped container at room temperature; protect from moisture.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies.
• Note hepatic or renal impairment and the nature of the patient's diabetes (type 1 vs type 2).
• Be aware that hypoglycemia may be difficult to recognize in the elderly.
• Check blood sugars frequently and observe for symptoms of hypoglycemia or hyperglycemia and report to health care provider.

  Patient/Family Education:

• Review diabetic dietary guidelines with patient.
• Instruct patient to take drug immediately before or up to 30 min before each meal.
• Instruct patients who skip a meal to skip their dose for that meal. If patient adds a meal they should be instructed to add a dose for that meal.
• Inform patient that this drug is not a substitute for exercise and diet control and that patient should follow prescribed regimens.
• Remind patient that follow-up visits will be required and to keep all appointments.
• Instruct patient to inform all health care providers involved in his/her care that he/she is taking this drug and to carry medical identification (eg, Medic-Alert bracelet).
• Instruct patient to notify health care provider if symptoms of hypoglycemia occur (eg, fatigue, excessive hunger, profuse sweating, rapid heart rate, numbness of extremities) or if blood glucose is < 60 mg/dL.
• Instruct patient to notify health care provider if symptoms of hyperglycemia occur (excessive thirst or urination) or if blood glucose is consistently above 200 mg/dL.
• Instruct patient to report these symptoms to health care provider: nausea, vomiting, diarrhea, or other physical complaints.
• Advise patient not to take any medication (including otc ) or alcohol without consulting health care provider.

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