Repaglinide

Repaglinide is a prescription medication used to treat type 2 diabetes. Repaglinide belongs to a group of drugs called meglitinides, which help lower blood sugar levels by causing the pancreas to secrete more insulin. 

This medication comes in tablet form and is taken before each meal. If you skip a meal you must skip the repaglinide dose.

Common side effects include headaches, low blood sugar levels, and upper respiratory infections.

Repaglinide is a prescription medication used with diet and exercise to treat type 2 diabetes.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Repaglinide may be found in some form under the following brand names:

• PrandiMet

• Prandin

Serious side effects have been reported with repaglinide.  See the “Drug Precautions” section.

Common side effects include:

• headaches
• low blood sugar levels
• upper respiratory infections
• diarrhea
• constipation
• back pain
• muscle pain

This is not a complete list of repaglinide side effects.  Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects.  You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.  Especially tell your doctor if you take:

• aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) such as:
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam, Flector, Voltaren, Zipsor and others)
  • etodolac (Lodine)
  • ibuprofen (Advil, Motrin, Nuprin)
  • indomethacin (Indocin, Indocin SR)
  • ketoprofen (Orudis, Actron, Oruvail)
  • ketorolac (Toradol)
  • meloxicam (Mobic)
  • nabumetone (Relafen)
  • naproxen (Naprosyn)
  • naproxen sodium (Aleve, Anaprox, Naprelan)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
• azole antifungals (ketoconazole, itraconazole, posaconazole, voriconazole)
• beta blockers such as:
  • metoprolol (Toprol XL, Lopressor)
  • carvedilol (Coreg)
  • bisoprolol (Zebeta)
  • betaxolol (Kerlone)
  • nebivolol (Bystolic)
  • propranolol (Inderal)
• birth control pills (oral contraceptives)
• calcium channel blockers such as:
  • nifedipine (Adalat, Nifedical, Procardia)
  • amlodipine (Norvasc)
  • verapamil (Calan, Isoptin, Covera-HS, Verelan)
  • diltiazem (Cardizem)
• carbamazepine (Tegretol, Equetro, Carbatrol)
• chloramphenicol (Chloromycetin)
• clarithromycin (Biaxin)
• conivaptan (Vaprisol)
• cyclosporine (Neoral, Gengraf, Sandimmune)
• darifenacin (Enablex)
• deferasirox (Exjade)
• delavirdine (Rescriptor)
• dihydroergotamine (Migranal)
• diuretics such as:
  • acetazolamide (Diamox)
  • amiloride (Midamor)
  • bumetanide (Bumex)
  • chlorothiazide (Diuril)
  • chlorthalidone (Thalitone)
  • ethacrynic acid (Edecrin)
  • furosemide (Lasix)
  • hydrochlorothiazide (Microzide, HCTZ)
  • metolazone (Zaroxolyn)
  • torsemide (Demadex)
  • triamterene (Dyrenium, Dyazide, Maxzide)
• eletriptan (Relpax)
• estrogens
• fentanyl (Abstral, Fentora, Onsolis, Actiq)
• fluvoxamine (Luvox)
• gemfibrozil (Lopid)
• HCV protease inhibitors (boceprevir, telaprevir)
• HIV protease inhibitors (indinavir, nelfinavir, ritonavir, saquinavir)
• isoniazid
• ketoconazole (Nizoral)
• lovastatin (Mevacor)
• macrolide antibiotics (clarithromycin, telithromycin)
• monoamine oxidase inhibitors such as:
  • tranylcypromine (Parnate)
  • phenelzine (Nardil)
  • selegiline (Eldepryl, Zelapar)
  • isocarboxazid (Marplan)
  • rasagiline (Azilect)
• nefazodone (Serzone)
• nicotinic acid medications such as niacin (Niacor, Niaspan, Slo-Niacin) and vitamin B3
• nimodipine (Nimotop)
• phenobarbital
• phenothiazines such as:
  • chlorpromazine (Thorazine)
  • thioridazine (Mellaril)
  • fluphenazine (Prolixin)
  • perphenazine
  • prochlorperazine (Compazine)
  • trifluoperazine (Stelazine)
• phenytoin (Dilantin)
• pimozide (Orap)
• probenecid (Probalan)
• quetiapine (Seroquel)
• quinidine (Cardioquin, Duraquin, Quinact)
• rifampin 
• sildenafil (Viagra, Revatio)
• simvastatin (Zocor)
• sirolimus (Rapamune)
• steroids such as:
  • prednisone (Cortan, Deltasone, Orasone, Sterapred)
  • budesonide (Entocort)
  • dexamethasone (Decadron)
  • triamcinolone (Kenacort, Aristocort)
  • flunisolide (AeroBid, Aerospan)
  • ciclesonide (Alvesco)
  • mometasone (Asmanex, Nasonex)
  • fluticasone (Flovent)
  • methylprednisolone (Medrol, Solu-Medrol)
  • fludrocortisone (Florinef)
  • hydrocortisone (Cortef, Hydrocortone)
• St. John's wort
• sulfonamides such as:
  • trimethoprim/sulfamethoxazole (Septra, Bactrim)
  • sulfasalazine (Azulfidine)
  • dapsone (DDS)
  • sumatriptan (Imitrex, Sumavel Dosepro)
  • zonisamide (Zonegran)
  • acetazolamide (Diamox)
  • celecoxib (Celebrex)
• tacrolimus (Prograf)
• terfenadine (Seldane)
• thyroid drugs such as levothyroxine (Synthroid, Levothroid)
• warfarin (Coumadin)

This is not a complete list of repaglinide drug interactions.  Ask your doctor or pharmacist for more information.

Serious side effects have been reported with repaglinide including:

• loss of blood sugar control. This may result in low blood sugar episodes, high blood sugar episodes, or both.

  • Tell your healthcare provider right away if you have some or all of the following symptoms of low blood sugar:

    • hunger
    • shakiness
    • dizziness
    • confusion
    • difficulty speaking
    • feeling anxious or weak

  • Tell your healthcare provider right away if you have some or all of the following symptoms of high blood sugar:

    • coma
    • convulsions
    • confusion
    • increased thirst
    • fever
    • frequent urination
    • nausea
    • lethargy
    • weight loss
    • weakness

• heart problems.  Tell your healthcare provider right away if you have some or all of the following symptoms of a heart problem:

  • chest pain
  • high blood pressure
  • abnormal heart beat

• thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. Tell your healthcare provider right away if you have the following signs and symptoms of thrombocytopenia:

  • mild to serious bleeding
  • purple, brown, and red bruises (purpura)
  • small red or purple dots on your skin (petechiae)
  • prolonged bleeding, even from minor cuts
  • bleeding or oozing from the mouth or nose, especially nosebleeds or bleeding from brushing your teeth
  • abnormal vaginal bleeding (especially heavy menstrual flow)
  • blood in the urine or stool or bleeding from the rectum. Blood in the stool can appear as red blood or as a dark, tarry color. Taking iron supplements also can cause dark, tarry stools.
  • headaches and other neurological symptoms. These problems are very rare, but you should discuss them with your doctor.

• leukopenia. This is a condition when there are a low number of white blood cells in your body. These cells help fight infections. Those who develop leukopenia are more likely to have fevers and infections.

• elevated liver enzymes in liver function tests.

• hypersensitivity (severe allergic reaction). Tell your healthcare provider about any signs or symptoms of hypersensitivity, which include the following:

  • chest pain
  • swelling of the face, eyes, lips, tongue, arms, or legs
  • difficulty breathing or swallowing
  • fainting
  • rash

Do not take repaglinide if you:

• are allergic to any of its ingredients
• have a condition called diabetic ketoacidosis
• have type 1 diabetes
• take a medication called gemfibrozil (Lopid)

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of repaglinide, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking repaglinide, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to any of its ingredients
• have a condition called diabetic ketoacidosis
• have type 1 diabetes
• have liver problems
• have heart problems
• have kidney problems
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Repaglinide falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if repaglinide crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using repaglinide.

Take repaglinide exactly as prescribed.

• Repaglinide comes in tablet form and is taken up to four times a day.
• Repaglinide should be taken by mouth before every meal, up to a half hour before meals.
• If you skip a meal, you must skip that repaglinide dosage as well. If you eat an extra meal, take an extra dose before that meal.
• If you take your repaglinide dose and then do not eat a meal within a half an hour, eat something as soon as possible. Taking repaglinide without a meal can cause low blood sugar (hypoglycemia).
• If you forget to take repaglinide before eating, wait until you eat again. Do not take 2 doses of repaglinide at the same time.

Take repaglinide exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The repaglinide dose your doctor recommends will be based on the following:

• other medical conditions you have
• other medications you are taking
• how you respond to the medication

The recommended dose range of repaglinide for the treatment of type 2 diabetes is 0.5 mg to 4 mg before meals. The maximum daily dose is 16 mg.

If you take too much repaglinide, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store repaglinide at room temperature.
• Keep away from heat and moisture.
• Keep this and all medicines out of the reach of children.