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Indications

Repaglinide is used in adults with type 2 diabetes, together with diet and exercise, alone or with Metformin, when blood sugar is not controlled well enough.

How It Works

Repaglinide belongs to the meglitinide group. It makes the pancreas release more insulin quickly and for a short time around meals. This lowers the rise in blood sugar after eating.

Dosage and Administration

Take it 15 minutes (anywhere from just before to 30 minutes before) each main meal.

Adults: the usual starting dose is 0.5 mg before each main meal, or 1 mg if switching from another diabetes medicine. The doctor may increase it every 1 to 2 weeks. The maximum is 4 mg before a meal and 16 mg in a day.

If you skip a meal, skip that dose. If you have an extra main meal, an extra dose may be taken, as advised.

Older people and people with kidney problems usually start on a low dose. Not for children under 18.

Interactions

• Gemfibrozil: must not be taken with Repaglinide (risk of severe low blood sugar).
• Clopidogrel: raises Repaglinide levels; usually avoided or used with great care.
• Clarithromycin, Itraconazole, Ketoconazole, Trimethoprim and Ciclosporin: may increase the risk of low blood sugar.
• Rifampicin, Carbamazepine and Phenytoin: may reduce its effect.
• Beta-blockers: can hide the warning signs of low blood sugar.
• Alcohol and other diabetes medicines: more risk of low blood sugar.

Contraindications

• Type 1 diabetes or diabetic ketoacidosis
• Severe liver disease
• Taking Gemfibrozil
• Allergy to Repaglinide

Side Effects

Common: low blood sugar (sweating, shaking, hunger, fast heartbeat, headache, confusion), stomach pain and diarrhoea.

Rare: liver problems, skin rash, vision changes while blood sugar settles.

If you have low blood sugar, take sugar, glucose tablets or a sweet drink at once, then eat a snack. Get emergency help for severe low blood sugar with confusion, fits or loss of consciousness (do not give anything by mouth to an unconscious person), yellowing of the skin or eyes, or swelling of the face and trouble breathing.

Pregnancy and Lactation

Repaglinide is not used in pregnancy; insulin is usually preferred. It is not recommended while breastfeeding.

Precautions and Warnings

• Eat regular meals and carry sugar or sweets with you.
• Check blood sugar as advised, especially when starting or changing the dose.
• Take care when driving; stop if you feel signs of low blood sugar.
• During serious illness, infection or surgery, insulin may be needed for a while.
• Take extra care in liver or kidney disease and in older people.

Overdose

Too much causes low blood sugar. Take sugar or a sweet drink, then food, and seek medical help. Low blood sugar can come back, so watch closely for several hours. If the person is unconscious, get emergency help.

Therapeutic Class

Antidiabetic medicine (meglitinide; mealtime glucose regulator).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.