Repaglinide

Brand names

• GlucoNorm
• Repaglinide

Usage

Used as an adjunct (supplemental) therapy to dietary measures and exercise to help control blood sugar levels in patients with type 2 diabetes mellitus. Repaglinide is the first in a new class of oral antidiabetic medicaments designed to control blood glucose levels following meals.

How it works

Repaglinide stimulates the pancreas to produce more insulin. Increased insulin levels reduce blood glucose by promoting the transport of glucose into muscle cells and other tissues, where it is used as a source of energy. The rapid onset and short duration of repaglinide's action make it effective in controlling glucose levels after a meal.

Side effects

Serious

Hypoglycemia (blood sugar levels that are too low), resulting in shakiness, headache, cold sweats, anxiety, and changes in mental state. Immediately ingest sugar containing food or drink. Inform your doctor about the frequency and timing of hypoglycemic events.

Common

Increased incidence of upper respiratory or sinus infection, headache, back pain, joint pain, diarrhea.

Less common

Constipation, indigestion, urinary tract infection, mild allergic reaction.

Possible interactions

Other medicaments:

The following medicaments may increase the effects of repaglinide:

• cimetidine (Tagamet).
• erythromycins.
• itraconazole (Sporanox).
• ketoconazole (Nizoral).
• medicines that inhibit or compete for CYP 3A4 (a liver enzyme) will increase repaglinide because it is removed by that enzyme.
• mibefradil (Posicor).
• nelfinavir (Viracept) and perhaps other protease inhibitors may increase blood levels.
• sildenafil (Viagra), since both medicaments are removed by CYP3A4.
• any medicine that interferes with cytochrome CYP3A4-will potentially increase repaglinide blood levels.

The following medicaments may decrease the effects 6f repaglinide:

• carbamazepine (Tegretol), since it induces CYP3A4, which removes repaglinide from the body.
• corticosteroids.
• rifabutin (Mycobutin).
• rifampin (Rifadin, Rimactane).

Foods:

Follow the diabetic diet prescribed by your physician.

Herbal medicines or minerals:

Using chromium may change the way your body is able to use sugar. Some health food stores advocate vanadium as mimicking the actions of insulin, but possible toxicity and need for rigorous studies presently preclude recommending it.
DHEA may change sensitivity to insulin or insulin resistance. Hawthorn, ginger, garlic, ginseng and licorice, nettle and yohimbe may change blood sugar. Since this may require adjustment of hypoglycemic medicine dosing, talk to your doctor before combining any of these herbal medicines with this medicament. Echinacea pupurea (injectable) and blonde psyllium seed or husk should not be taken by people living with diabetes.

Beverages:

As directed in the diabetic diet.

Alcohol:

Use with extreme caution-alcohol can exaggerate this medicament's hypoglycemic effect.

Discontinuation:

It is advisable not to interrupt or stop this medicament without consulting your physician.

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