Repaglinide

Repaglinide
(Antidiabetic Agents)

Dosage form	Brand	Strength
Tablet	Novonorm®	0.5,1,2 mg

Indication : Management of type2 diabetes mellitus (noninsulin dependent, NIDDM) as an adjunct to diet and exercise; may be used in combination with metformin or thiazolidinediones

Mechanism of action : Nonsulfonylurea hypoglycemic agent  which blocks  ATP-dependent potassium channels, depolarizing the membrane and facilitating calcium entry through calcium channels. Increased intracellular calcium stimulates insulin release from the pancreatic beta cells. Repaglinide-induced insulin release is glucose-dependent.

Pregnancy Category  C

Contraindication : Diabetic ketoacidosis; severe hepatic impairment, type1 diabetes; hypersensitivity,Lactation

 Precaution : Myocardial infarction, coma, trauma during surgery, elderly, malnourished and debilitated patients. Hepatic or severe renal impairment. Pregnancy.

Drug Interaction :  MAOIs, nonselective β-blockers, ACE inhibitors, NSAIDs, salicylates, octreotide, alcohol & anabolic steroids. thiazides, corticosteroids, danazol, thyroid hormones & sympathomimetics, sulphonylurea.

Side Effect : Common : Diarrhea; headache; joint or back pain; nasal or chest congestion; sinus inflammation.

Severe : Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest

Monitoring parameters : Monitor fasting blood glucose (periodically) and glycosylated hemoglobin (Hb A1c) levels (every 3 months) with a goal of decreasing these levels towards the normal range. During dose adjustment, fasting glucose can be used to determine response.

Usual Dose : Initial : 0.5 mg PO ac (Hb A1c<8%) 1 or 2 mg PO ac (Hb A1c≥8%)

Dose adjustment : Usually fasting blood glucose.Double the preprandial dose up to 4 mg until satisfactory blood glucose response is achieved

Patient Education : Educate patient or caregiver regarding diabetes and its management, including target ranges for blood sugar control. Instruct patient or caregiver that this medication is not a substitute for diet and exercise, and to continue to follow prescribed regimens.

Missed Dose : if meal is missed, to skip the dose for that meal to reduce risk of hypoglycemia.

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