Diet and exercise are the two basic treatments for type 2 diabetes. However, patients are often prescribed medication to aid the reversing process. Prandin (Repaglinide) is one of such drugs. It’s available in a form of oral tablets, and there’s a lot to know about it.
What does Repaglinide do? What are the side effects? What limitation range does it have? All this and more, you’ll find in this easy-to-understand guide.
What Is Prandin (Repaglinide)?
Repaglinide is a medication in the form of tablets that is used as an addition to diet and workouts to stabilize blood sugar levels in adult patients with type 2 diabetes mellitus. The dosage can be different and taken before the meal 2-4 times a day.
The medication can be taken as a part of a dual therapy course along with metformin or another similar drug or alone.
It has a bioavailability of 56%, 15-60 minute onset, and a duration of 4-6 hours.
The manufacturer has obtained a new patent before the old patent term expiration date.
To know better what Repaglinide is, it’s important to know how it works.
Repaglinide Mechanism of Action
Repaglinide’s mechanism of action is relatively easy to understand. It stimulates β-islet cells (beta cells in our pancreas) to release insulin. The effect is almost immediate but lasts for a short amount of time.
The stimulating process is done due to ATP potassium channel blockage. This increases calcium entrance through its channels, which triggers insulin release.
Such a mechanism of action of Repaglinide promotes weight gain and increases blood pressure. So, when taking the drug, make sure you eat healthy and workout regularly.
Dose and Administration
A Repaglinide dose has to be taken 15-30 minutes before the main meal. You can be prescribed 2-4 doses a day, depending on your individual condition and glucose-lowering needs.
There are the following dosage forms:
- Generic: 0,5 mg, 1 mg, 2 mg;
- Prandin: 1 mg, 2 mg.
Recommended Dosage
The dose of Repaglinide depends on your case. It will be decided by the doctor. However, the starting dose is:
- if HbA1c is lower than 8%: 0.5 mg orally before each main meal;
- if HbA1c equals or is higher than 8%: 1-2 mg orally before each main meal.
The maximum daily dose of the drug is 16 mg, you may take 0.5-4 mg before every meal. Don’t assign a dose yourself; let a doctor go through your medical history and see if dose adjustment is needed.
Dose Modifications for Drug Interactions
Prandin interacts with a lot of drugs.
Doctors recommend an adjustment of a dose for everyone taking the following medications:
- concomitant strong CYP3A4 or CYP2C8 inhibitors;
- strong CYP3A4 or CYP2C8 inducers.
If you take Clopidogrel, and it’s impossible to substitute Prandin with another medication, take only 0.5 mg before each meal. The daily dose shouldn’t be more than 4 mg.
If you’re taking Cyclosporine, adjust the dose to be under 6 mg a day.
In case when Repaglinide doesn’t help, you can opt for dual therapy and add:
- Metformin;
- Thiazolidinedione.
Don’t assign any medication yourself. Always talk to the doctor and have test results to prove that you need a change of treatment or dose adjustment.
Dosage for Different Age Groups
Prandin is only suitable for adults. There’s no proof of efficacy and safety in child treatment.
However, there are dose adjustments according to the additional conditions you may have:
- If you notice symptoms of hypoglycemia, reduce the dose and contact your doctor for a potential adjustment.
- If you have a renal impairment (kidney function failure), there are three potential outcomes:
- CrCl 40-80 mL/min – no changes needed;
- CrCl 20-40 mL/min – only 0.5 mg with a meal and further condition monitoring;
- CrCl <20 mL/min – no data available; potentially, you should use another medication.
- If you have a hepatic impairment, strict standard dosages can be used. However, you need to wait for a longer time to see if an adjustment is needed.
Whenever you adjust a dose, remember that no more than 4 mg of Prandin can be taken at once. The next assessment has to be made at least after a week.
How Is This Medication Supplied?
When taking the drug, you should always follow the directions in the instruction for use. It’s also essential to consult your doctor as to the daily dosage, additional medication, etc.
Keep in mind that if you skip a meal, don’t take Repaglinide either. It’s better to wait for another meal and take the tablet than. During the course, check blood sugar levels often and see if glucose concentrates. If so, talk to your doctor about dose adjustment or dual therapy.
Don’t forget that hypoglycemia is a common effect. You may feel very hungry, shaky, dizzy, and easily annoyed. Anxiety and confusion may also be frequent. If you feel such symptoms, eat a snack or drink something with sugar in it. Consider talking to your doctor about the food and drinks you’re allowed to consume.
It’s possible that you’ll also be prescribed a glucagon injection kit for emergencies. If you have severe hypoglycemia, use this kit. Make sure your family and friends know about your condition and that you have this kit. They may need to perform the procedure themselves in case you won’t be able to.
Hyperglycemia is a reverse condition when there’s too much sugar in your blood. The major symptom is increased urination and constant thirst. The level of glucose isn’t affected only by medication. Your diet, exercise, surgery, stress, alcohol, or inconsistent meals can all lead to hypo or hyperglycemia.
It’s crucial to remember that type 2 diabetes treatment is a complex of a healthy lifestyle, medication (when needed), frequent blood sugar tests, close monitoring of your condition, and other procedures.
Dosage Forms and Strengths
Prandin (Repaglinide) is manufactured in a form of oral tablets only. There are:
- 0.5 mg tablet;
- 1 mg tablet;
- 2 mg tablet.
A certain dosage is assigned according to your condition and the need to lower blood sugar levels.
Storage and Handling
The medication Prandin has to be stored at room temperature, in a place with low humidity and no heat and/or direct sunlight. Keep it out of reach of children and pets as the drug can be dangerous and isn’t suitable for kids.
Don’t share the medicine with anybody, even if the person has a similar condition. Everyone is different, has various allergies and other factors that may make Prandin not a suitable option for them.
Dispose of the drug properly, according to FDA recommendations:
- Mix the tablets with a substance that is unpleasant to touch and look for something in it;
- Put the mixture in a plastic bag;
- Add to your regular trash;
- Throw away.
If possible, ask a pharmacist if there are special disposal facilities near your location.
Prandin Drug Class
The drug class of Prandin is glinide. Such medications are used specifically for the treatment of type 2 diabetes. The drug class of Prandin is also called meglitinides. Their mechanism of action stimulates insulin release, which helps lower blood sugar levels and stabilizes them.
If you lead a healthy lifestyle and follow a low-carb diet, the need for the drug may decrease.
The Main Contraindications
There’s a fair share of contraindications for Prandin, but they are all clear. Make sure you tell your doctor about any pre-existing condition, metabolic issues, or the drugs you take along with this one.
Here are some of the common contraindications:
- Hypoglycemia.
The use of Repaglinide is safe only with constant monitoring. If the symptoms of hypoglycemia appear during the course of the drug, it should be substituted, or the dose should be adjusted. The patient, friends, and family have to be instructed on how to recognize and cope with the symptoms. - Fever, infections, traumas, upcoming or recent surgery.
Anything that induces physiologic stress can alter glucose levels. So, if you take Prandin, temporary insulin treatment may be necessary (not isophane insulin (NPH), though). - Hepatic disease.
Liver function is vital in this case because it metabolizes Prandin. If the function is failing or abnormal, and you’re taking medication to treat it, the drug doses should be either adjusted or not administered at all. - Geriatric.
Geriatric or malnourished patients have a higher sensitivity to the drug, so it has to be assigned with caution or not assigned at all. - Pregnancy.
There isn’t sufficient information on the use of Repaglinide during pregnancy. However, the danger of fetal harm and other risks exist. The American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association (ADA) recommend insulin treatment for pregnant women with type 2 diabetes. The lack of control of the condition is also dangerous. - Breast-feeding.
The drug shouldn’t be used if the mother is still in the lactation stage. There’re no clear data about the drug entering human milk, but the risks are real. - Children.
People younger than 18 years old shouldn’t take Prandin since the possibility of adverse effects is increased.
For People with Diabetic Ketoacidosis
Diabetic ketoacidosis has to be treated with insulin directly. Repaglinide is contraindicated in such cases, no matter if the patient has or doesn’t have a coma.
For People with Type 1 Diabetes
Repaglinide shouldn’t be assigned to people with type 1 diabetes. The drug stimulates beta-cells, and in type 1, they are absent. So, the medicine won’t be effective and can do more harm than good.
For People with Known Hypersensitivity to the Drug
If there’s known hypersensitivity to the drug, the possibility of adverse side effects increases. There are other medicines in this class, so your doctor can choose one that will be safer.
Repaglinide Side Effects
Side effects of Repaglinide include:
- signs of an allergic reaction to the drug;
- pale or yellowed skin;
- rapid change in urine color (dark brown is a side effect);
- fever;
- sense of confusion;
- pancreatitis;
- nausea, diarrhea;
- severe joint pain or headache;
- cold symptoms.
Other side effects of Prandin may occur. If you notice any of the mentioned signs, contact your doctor and report the condition to FDA at 1-800-FDA-1088.
Shakiness
Shakiness is one of the most common Repaglinide side effects caused by hypoglycemia. The lowering of blood sugar levels leads to loss of energy, which causes shaking and the feeling of cold.
Dizziness
Another consequence of hypoglycemia is dizziness. Eat a healthy snack to increase the levels of sugar in your blood a little bit. Sit or lie down to avoid fainting. If you feel like this doesn’t help, call 911, have your injection kit nearby, and ask for a family member or a friend to assist.
Nervousness or Irritability
Nervousness and irritability are also connected to hypoglycemia and blood pressure. Any physiological stress may cause changes in how your glucose levels behave. Consult your doctor on the sedatives you can take with Prandin to eliminate this side effect.
Pale Skin
The drug Prandin causes pale skin due to hypoglycemia. If it doesn’t bother you too much, it’s fine. But if there are other side effects, contact your doctor.
Headache
Due to the same main side effect of hypoglycemia, you may get frequent headaches. If they are too severe, contact the doctor.
What to Do in Case of Emergency /Overdose
Generic Prandin should be taken strictly before a meal. If you miss a dose or a meal, don’t try to compensate it. If you overdose, call 911 or reach the Poison Helpline at 1-800-222-1222. A Repaglinide overdose can cause life-threatening hypoglycemia.
Extreme hypoglycemia can have a fatal outcome. The symptoms include troubles with speaking and vision, severe weakness, seizures, stomach pain, etc.
Prandin’s Interactions
Numerous drugs interact with Prandin. Some of them are highly not recommended to be used together or used in adjusted doses:
- clopidogrel;
- cyclosporine;
- gemfibrozil;
- NPH insulin (isophane insulin).
Over-the-counter drugs, herbal teas, and even vitamins can interact with the drug. Tell your doctor if you’re taking anything else.
You can find more drug interaction information here.
Risks And Warnings
Here’s a list of basic risks and warnings:
- Repaglinide is only used for treating type 2 diabetes, not for type 1 diabetes, liver disease, or diabetic ketoacidosis.
- Follow all the directions of use that your doctor had prescribed, even if they differ from what’s written in the instruction.
- Tell your doctor if you are or plan to become pregnant in the nearest future.
- Avoid drinking alcohol when taking Prandin. It will lower blood sugar levels and cause hypoglycemia in combination with the drug.
Prandin can improve your condition if used properly along with other elements of treatment, such as a healthy lifestyle and additional medication (if necessary).
Drugs Similar to Prandin (Repaglinide)
Several drugs similar to Prandin (repaglinide) belong to the class of meglitinides, which work by stimulating insulin secretion from pancreatic beta cells. One alternative is nateglinide, marketed under the brand name Starlix, which shares a similar mechanism of action with repaglinide in promoting insulin release to lower blood sugar levels. Another option is mitiglinide, a meglitinide available in some regions, which operates similarly to repaglinide in enhancing insulin secretion in response to mealtime glucose surges.
These medications provide alternatives to Prandin for individuals requiring pharmacological interventions to improve insulin secretion and achieve glycemic control, particularly in managing postprandial hyperglycemia. However, it’s crucial to consider individual patient factors such as meal patterns, glucose variability, and potential drug interactions when selecting the most suitable medication from this class.