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Repaglinide: Brands, Price & Uses in Bangladesh
Repaglinide is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
About Repaglinide
Indications of Repaglinide
Repaglinide is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
- Monotherapy: Repaglinide is FDA-approved for use alone when diet and exercise alone do not adequately control blood glucose.
- Combination therapy: Repaglinide is FDA-approved for use in combination with metformin, or with thiazolidinediones (e.g. pioglitazone), in patients whose type 2 diabetes is not adequately controlled on either agent alone.
Repaglinide is not indicated for type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.
Dosage & Administration of Repaglinide
General Dosing Principles
Repaglinide should be taken shortly before meals (typically within 15–30 minutes of eating), 2, 3, or 4 times daily depending on the number of meals eaten.
| Indication | Dosing |
|---|---|
| Initial dose (patients not previously treated, or HbA1c < 8%) | 0.5 mg with each meal |
| Initial dose (patients previously treated with another glucose-lowering agent, or HbA1c ≥ 8%) | 1 mg or 2 mg with each meal |
| Dose titration | Double the pre-meal dose (up to 4 mg per meal) at intervals of at least one week, based on blood glucose response |
| Maximum dose | 4 mg per meal; total daily dose should not exceed 16 mg |
| Combination with metformin or a thiazolidinedione | Use the same dosing/titration schedule as monotherapy, added to the existing agent |
Meal-Related Timing (Important)
Repaglinide must be taken shortly before a meal. If a meal is skipped, the corresponding dose of Repaglinide should also be skipped to reduce the risk of hypoglycemia; if an extra meal is eaten, an extra dose should be taken before that meal. This "one meal, one dose; no meal, no dose" rule is a defining feature of Repaglinide dosing, distinguishing it from once-daily oral antidiabetics.
Hepatic Impairment
Use with caution and extend dosing intervals during dose titration in patients with hepatic impairment, as clearance of Repaglinide is reduced. Repaglinide is contraindicated in severe hepatic impairment (see Contraindications).
Renal Impairment
No initial dose adjustment is required for mild-to-moderate renal impairment, but titration should proceed cautiously. In patients with renal impairment or on dialysis, an initial dose of 0.5 mg with meals is recommended, with careful titration and monitoring due to increased hypoglycemia risk.
Elderly Patients
Use the same dosing principles with cautious, conservative titration, given increased sensitivity to hypoglycemia in older adults.
Side Effects of Repaglinide
Common
- Hypoglycemia (the most common adverse effect; see Precautions and Warnings)
- Upper respiratory tract infection
- Headache
- Nausea, diarrhea, constipation, abdominal pain
- Arthralgia, back pain
Less Common / Serious
- Allergic reactions (rash, pruritus, urticaria; rarely anaphylaxis or severe cutaneous reactions)
- Elevated liver enzymes (rare reports of hepatic dysfunction)
- Cardiovascular events have been reported in trials; causal relationship to Repaglinide not firmly established
Contraindications of Repaglinide
- Known hypersensitivity to Repaglinide or any component of the formulation.
- Type 1 diabetes mellitus.
- Diabetic ketoacidosis, with or without coma.
- Severe hepatic impairment.
- Concomitant use with gemfibrozil (see Interactions).
Frequently Asked Questions about Repaglinide
When should I take Repaglinide?
Take Repaglinide shortly before each meal, usually within 15–30 minutes of eating. If you skip a meal, skip that dose of Repaglinide; if you eat an extra meal, take an extra dose before it. This meal-matched dosing helps control blood sugar rise from food while minimizing the risk of low blood sugar between meals.
What happens if I take Repaglinide but then don't eat?
Taking Repaglinide without eating a meal significantly increases your risk of hypoglycemia (low blood sugar), which can cause sweating, shakiness, confusion, and in severe cases, seizures or loss of consciousness. Always eat shortly after taking Repaglinide, and skip the dose entirely if you are going to skip the meal.
Can I take Repaglinide together with gemfibrozil?
No. Repaglinide should never be taken together with gemfibrozil (a cholesterol-lowering fibrate medicine). Gemfibrozil markedly raises Repaglinide levels in the blood and greatly increases the risk of severe, prolonged low blood sugar. Tell your doctor about all medicines you take, including gemfibrozil, before starting Repaglinide.
Is Repaglinide safe during pregnancy or breastfeeding?
Data on Repaglinide in pregnancy are limited, and insulin is generally preferred for blood sugar control during pregnancy. Repaglinide should be used in pregnancy only if clearly needed and your doctor decides the benefit outweighs the potential risk to the baby. It is also generally not recommended while breastfeeding because it may pass into breast milk and cause low blood sugar in the infant; discuss safer alternatives with your physician.
Can Repaglinide be used in type 1 diabetes?
No. Repaglinide is contraindicated in type 1 diabetes mellitus and in diabetic ketoacidosis. It works by stimulating the pancreas to release insulin, so it is only effective in type 2 diabetes, where the pancreas can still produce insulin.
What should I do if I think I've taken too much Repaglinide?
An overdose of Repaglinide can cause severe low blood sugar (hypoglycemia), with symptoms such as sweating, tremor, confusion, or fainting. If you suspect an overdose, seek immediate medical attention or contact emergency services/poison control right away. Do not try to manage a serious overdose at home.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.