Buy Prandin Online

Prandin (repaglinide)

THERAPEUTIC CLASS

Meglitinide

DEA CLASS

RX

INDICATIONS

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM).

ADULT DOSAGE

Type 2 Diabetes Mellitus

Administer dose w/in 15-30 min ac, bid-qid in response to changes in meal pattern

Initial:
Not Previously Treated or HbA1c <8%: 0.5mg w/ each meal preprandially
Previously Treated and HbA1c ≥8%: 1mg or 2mg w/ each meal preprandially
Titrate: May double preprandial dose up to 4mg until satisfactory blood glucose response; at least 1 week should elapse to assess response after each dose adjustment
Range: 0.5-4mg w/ meals preprandially
Max: 16mg/day

Replacing Other Oral Hypoglycemics:
Repaglinide may be started on the day after the final dose is given; observe carefully for hypoglycemia due to potential overlapping drug effects. Close monitoring for up to 1 week or longer may be indicated when transferred from longer half-life sulfonylurea agents (eg, chlorpropamide)

Combination Therapy:
May add metformin or a thiazolidinedione if repaglinide monotherapy does not result in adequate glycemic control; may add repaglinide if metformin or thiazolidinedione monotherapy does not provide adequate control
Starting dose and dose adjustments for repaglinide combination therapy is the same as for repaglinide monotherapy

DOSING CONSIDERATIONS

Concomitant Medications
W/ Thiazolidinedione or w/ Metformin:
If hypoglycemia occurs in patients taking a combination of repaglinide and a thiazolidinedione or repaglinide and metformin, reduce dose of repaglinide

Renal Impairment
Severe (CrCl 20-40mL/min):
Initial: 0.5mg ac; titrate carefully

Hepatic Impairment
Utilize longer intervals between dose adjustments to fully assess response

ADMINISTRATION

Oral route

Take w/in 15-30 min ac

HOW SUPPLIED

Tab: 0.5mg, 1mg, 2mg

CONTRAINDICATIONS

Diabetic ketoacidosis with or without coma, type 1 DM, concomitant gemfibrozil.

WARNINGS/PRECAUTIONS

May cause hypoglycemia; risk increased in elderly, debilitated or malnourished patients, or with adrenal, pituitary, hepatic, or severe renal insufficiency. Loss of glycemic control may occur when exposed to stress; may need to d/c therapy and administer insulin. Secondary failure may occur; assess adequate dose adjustment and adherence to diet before classifying a patient as a secondary failure. Caution with hepatic impairment.

ADVERSE REACTIONS

Hypoglycemia, upper respiratory infection, headache, rhinitis, sinusitis, bronchitis, arthralgia, back pain, N/V, diarrhea, dyspepsia, constipation, paresthesia, chest pain.

DRUG INTERACTIONS

See Contraindications. Not for use in combination with NPH-insulin. CYP3A4 and/or CYP2C8 inducers (eg, barbiturates, carbamazepine), CYP3A4 inhibitors (eg, erythromycin), and CYP2C8 inhibitors (eg, montelukast) may alter metabolism; use with caution. OATP1B1 inhibitors (eg, cyclosporine), itraconazole, ketoconazole, clarithromycin, trimethoprim, and deferasirox may increase levels. Rifampin may decrease levels. NSAIDs, highly protein-bound drugs, salicylates, sulfonamides, cyclosporine, chloramphenicol, coumarins, probenecid, MAOIs, β-blockers, alcohol, and >1 glucose-lowering drug may potentiate hypoglycemic action. Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid tend to produce hyperglycemia and may lead to loss of glycemic control. β-blockers may mask hypoglycemia. May increase ethinyl estradiol levels and levonorgestrel Cmax. Levonorgestrel/ethinyl estradiol combination and simvastatin may increase Cmax.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Meglitinide; lowers blood glucose levels by stimulating the release of insulin from the pancreas.

PHARMACOKINETICS

Absorption: Rapid and complete. Absolute bioavailability (56%); Tmax=1 hr. See PI for parameters of different doses. Distribution: (IV) Vd=31L; plasma protein binding (>98%). Metabolism: CYP2C8, 3A4; oxidation, and direct conjugation with glucuronic acid; oxidized dicarboxylic acid (M2), aromatic amine (M1), acyl glucuronide (M7) (major metabolites). Elimination: Feces (90%, <2% unchanged), urine (8%, 0.1% unchanged); T1/2=1-1.4 hrs.

ASSESSMENT

Assess for diabetic ketoacidosis, type 1 DM, adrenal/pituitary/hepatic/severe renal insufficiency, drug hypersensitivity, pregnancy/nursing status, and possible drug interactions. Assess FPG, postprandial glucose (PPG), and HbA1c.

MONITORING

Monitor for hypo/hyperglycemia, secondary failure, and other adverse events. Monitor FPG, PPG, HbA1c, and renal/hepatic function.

PATIENT COUNSELING

Inform of potential risks/benefits of therapy, alternative modes of therapy, the importance of adherence to dietary instructions, regular exercise program, and regular blood glucose and HbA1c testing. Inform about risks of hypoglycemia, its symptoms and treatment, and predisposing conditions. Instruct to take drug ac (bid-qid preprandially); if a meal is skipped (or an extra meal is added), instruct to skip (or add) a dose for that meal.

STORAGE

≤25°C (77°F). Protect from moisture.

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