Repaglinide is a novel new class of insulin secretagogues, introduced in India and world recently, which acts at distinctly different enzyme system from all other insulin releasing agents. It is used to treat only Type 2 diabetes, where there is still some viable Beta cells left in the pancreas to synthesize and release insulin when stimulated by the drug. It may be used alone or with insulin resensitizer drugs like metformin, Rosiglitazone or Pioglitazone.
This drug only stimulates the first phase of insulin release, and therefore acts to mimic the natural rise and rapid fall of insulin blood levels in response to food intake. If no food is taken, then there is no rise in insulin levels. It acts very rapidly, and needs to be taken only 10 to 20 minutes before meals. The duration of action per dose is about 3 to 4 hours. It is recommended to take a pill per meal and no pill for no meal. The drug acts synergistically with insulin resensitizers like metformin, rosiglitazone and pioglitazone.
This drug does not help patients who are incapable of producing any insulin (beta cell failure). In such cases, the blood glucose is best controlled by insulin injections, supplemented by a insulin resensitizer where needed.
Tablets of 0.5 mg, 1 mg, 2 mg.
The dose of repaglinide has to be individualized as per you need by your doctor. The following information includes only the average doses of repaglinide. If your dose is different, do not change it unless your doctor tells you to do so.
- For oral dosage form (tablets):
- Initial dose is 0.5 milligram (mg) fifteen to thirty minutes before each meal, going up to about 4 mg per meal up to a maximum of 12 mg per day, depending upon individual response and the status of liver and kidney function.
- Children: Use and dose must be determined by your doctor.
Missed dose–You should skip a dose of repaglinide if a meal is skipped and add a dose of repaglinide if you eat an extra meal.
Before Using This Medicine
Your doctor needs to know some information about you before you are prescribed this drug. Tell him about the following:
- Allergies–Any unusual or allergic reaction to such drugs? Also tell your doctor if you are allergic to any other substances, such as foods, preservatives, or dyes.
- Pregnancy–No oral antidiabetic drug is recommended during pregnancy. If you are pregnant or contemplating pregnancy, you need to be on insulin for the duration of pregnancy, in the best interests of your baby.
- Breast-feeding–The drug has shown some adverse effects when used in lactating animals. Hence it is not recommended in lactating mothers, who are better managed with insulin, till such times that more data is available in humans.
- Children–Due to ethical reasons, studies on this medicine have been done only in adult patients, and there is no scientific information comparing use of such drugs in children with use in other age groups.
- Adolescents–Due to ethical reasons, studies on this medicine have been done only in adult patients, and there is no specific information comparing use of such drugs in teenagers with use in other age groups.
- Older adults–Repaglinide does not seem to cause any problems in older patients. However, since older patients show less symptoms of low blood sugar, hence it should be used with caution in such patients.
- Other medicines— Such drugs interacts with many drugs and chemicals, whose simultaneous use must be done with caution if at all:
- Beta-adrenergic blocking agents like atenolol, metoprolol, carvedilol, etc.
Other medical problems–The following medical problems make changes within the body environment, which may increase risk of side effects. They include:
- High fever, Infection or Ketones in the blood (diabetic ketoacidosis)
- Surgery, Trauma
- Type 1 (insulin-dependent) diabetes
- Unusual stress–Insulin may be needed to control diabetes in patients with these conditions
- Moderate to severe Kidney disease or Liver disease
- Hormonal disturbances due to disease of pituitary gland, adrenal gland
- Undernourished condition or Weakened physical condition
Proper Use of This Medicine
The use of repaglinide follows and does not replace the importance and need of regular exercise and a balanced diet plan as given by your doctor. This drug should be taken 15 minutes before a meal but may be taken up to 30 minutes before a meal .
Precautions While Using This Medicine
Your doctor needs to know some background information about you before the use of such drugs. Be sure to tell him about:
- Alcohol usage
- Other medicines which may interact with these drugs: your doctor knows best
- Counseling–Teach your family members to recognize side effects like low blood sugar, and what to do about it.
- Seek a gynecologists opinion if planning for child. Women may need to be switched over to insulin during pregnancy and lactation.
- Travel–Carry a copy of your recent prescription, brief disease history, and a small packet of glucose to use in case of sudden low blood sugar. Take you meal at usual meal times as far as possible.
Be prepared for an emergency:
- Wear a locket or identification batch or keep a identification card in your wallet storing your disease details and drug history, including emergency medicines that should be given you in case you are unconscious or unable to communicate your needs.
- Keep a small pouch / bottle of glucose handy to treat low blood sugar. Ordinary sugar is sucrose, which needs to be broken down to glucose and fructose, then absorbed and then work …… a needless waste of time.
As told earlier, tell any doctor you go to, about your intake of repaglinide, including a radiologist or pathologist. Many drugs for other conditions, and investigation procedures demand modification of blood sugar therapy.
Side Effects of This Medicine
|Rare||Convulsions (seizures); unconsciousness, Peeling of skin; skin redness, itching, or rash|
|Chest pain; chills; coughing up blood; dark urine; fever; fluid-filled skin blisters; general feeling of illness; increased amounts of sputum (phlegm); increased sweating; light-colored stools; pale skin; sensitivity to the sun; shortness of breath; sore throat; thinning of the skin; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin|
|More common||Low blood sugar, including anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, unusual tiredness or weakness; unusual weight gain|