Diabetes Oral Antidiabetic Drugs: Meglitinides
Repaglinide (Novonorm) is the first of a relatively new group of non-sulphonylureas which has a fast-acting effect upon insulin secretion. Its metabolic action is somewhat different to that of the sulphonylureas but it has been shown to be highly effective in lowering blood glucose levels. Repaglinide is designed for use only when a meal is about to be eaten and it is ideally taken 30 minutes before eating. It has a short half-life of less than 60 minutes and acts very rapidly to lower blood glucose levels after a meal has been consumed. Evidence suggests that there may be a lower risk of severe hypoglycaemia with repaglinide compared to sulphonylureas. Studies also suggest that only a modest weight gain is associated with the use of this drug. Repaglinide is metabolized by the liver and most is excreted in bile, hence there is minimal involvement of the kidneys. However, it is not normally recommended for people with significant liver or kidney disease. Repaglinide is designed to be used as monotherapy or in combination with metformin, if there is still insufficient control of blood glucose levels. It provides an alternative to sulphonylureas for people with Type 2 diabetes for whom dietary and lifestyle measures are insufficient. However, it allows for greater flexibility since it is only taken when a meal is to be eaten. Repaglinide is only suitable for people who retain sufficient beta cells able to produce insulin. Since its use is associated with some weight gain, it is probably most suitable for those of normal weight.
There are a number of drugs that interact with repaglinide:
- ACE inhibitors: a group of drugs used to treat heart conditions and high blood pressure
- alcohol
- anabolic steroids: hormonal type drugs used to promote the build up of body tissues and to treat certain forms of anaemia
- azole antifungal drugs used to treat fungal infections
- beta-blockers: drugs used to treat heart conditions, anxiety, hypertension, and migraine
- contraceptive pills
- corticosteroids: hormonal preparations used to treat disorders of the adrenal glands and inflammatory conditions such as rheumatoid arthritis
- danazol (Danol): used to treat heavy periods, endometriosis and some breast disorders
- erythromycin: antibiotics used to treat many bacterial infections
- monoamine oxidase inhibitors (MAOIs)
- non-steroidal anti-inflammatory drugs (NSAIDs): used for inflammatory conditions such as rheumatoid arthritis
- octreotide (Sandostatin): used in hospital to treat pituitary gland and pancreatic tumours
- phenytoin (Epanutin): used in hospital to treat irregular heartbeat and epileptic seizures
- rifampicin
- sympathomimetics: drugs used to treat respiratory disorders such as bronchitis and asthma and also in emergencies for shock and acute low blood pressure
- thiazide diuretics: used to treat some heart conditions and high blood pressure
- thyroid hormones: used to treat disorders of the thyroid gland.
Apart from hypoglycaemia, side-effects associated with the use of repaghnide are generally slight and are similar to those which may occur with sulphonylureas, with possible visual disturbances also having been reported. Anyone experiencing side-effects should report these to their diabetes clinical care team. Repaglinide tablets are available in 0.5 mg, 1 mg and 2 mg dosages and it is usual to start with the smallest dose, increasing this to a maximum 4 mg single dose (i.e. 2X2 mg tablets), if necessary. The maximum daily dose is 16 mg (i.e. 2X2 mg tablets, 4 times a day, taken before meals). People who are transferring from another form of antidiabetic medication are usually started on an initial 1 mg dose of repaglinide.
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