Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM).
Type 2 Diabetes Mellitus
Monotherapy and Combination w/ Metformin or a Thiazolidinedione:
Initial/Maint: 120mg tid ac; may use 60mg dose in patients near goal HbA1c when treatment is initiated
Moderate to Severe: Use caution
Take 1-30 min ac
Patients who skip meals should also skip their scheduled dose of nateglinide to reduce risk of hypoglycemia
Tab: 60mg, 120mg
Type 1 DM, diabetic ketoacidosis.
Risk of hypoglycemia increased with strenuous exercise, adrenal/pituitary insufficiency, severe renal impairment, and in elderly/malnourished patients. Autonomic neuropathy may mask hypoglycemia. Caution in moderate to severe hepatic impairment. Transient loss of glucose control may occur with fever, infection, trauma, or surgery; may need insulin therapy instead of nateglinide. Secondary failure (reduced effectiveness over a period of time) may occur.
Upper respiratory infection (URI), flu symptoms, dizziness, arthropathy, diarrhea, hypoglycemia, back pain, jaundice, cholestatic hepatitis, elevated liver enzymes.
Alcohol, NSAIDs, salicylates, MAOIs, nonselective β-blockers, guanethidine, and CYP2C9 inhibitors (eg, fluconazole, amiodarone, miconazole, oxandrolone) may potentiate hypoglycemia. Thiazides, corticosteroids, thyroid products, sympathomimetics, somatropin, rifampin, phenytoin, and dietary supplements (St. John's wort) may reduce hypoglycemic action of drug. Somatostatin analogues may potentiate/attenuate hypoglycemia. Reduced levels reported with liquid meals. β-blockers may mask hypoglycemic effects. Caution with highly protein-bound drugs.
PREGNANCY AND LACTATION
Category C, not for use in nursing.
MECHANISM OF ACTION
Meglitinide; lowers blood glucose levels by stimulating insulin secretion from the pancreas.
Absorption: Rapidly absorbed. Absolute bioavailability (73%); Tmax=1 hr. Distribution: Vd=10L (IV); plasma protein binding (98%). Metabolism: CYP2C9, 3A4; hydroxylation, glucuronide conjugation. Elimination: Urine (75%), feces; T1/2=1.5 hrs.
Assess for diabetic ketoacidosis, type 1 DM, renal/hepatic impairment, adrenal/pituitary insufficiency, pregnancy/nursing status, other conditions where treatment is cautioned, and possible drug interactions. Assess FPG and HbA1c.
Monitor for hypo/hyperglycemia, diabetic ketoacidosis, secondary failure, URI, and other adverse reactions. Monitor FPG, HbA1c, renal function, and LFTs.
Inform of potential risks, benefits, alternate modes of therapy, and drug interactions. Instruct to take 1-30 min ac, but to skip scheduled dose if meal is skipped. Inform about importance of adherence to meal planning, regular physical activity, regular blood glucose monitoring, periodic HbA1c testing, recognition and management of hypo/hyperglycemia, and periodic assessment for diabetes complications. Advise to notify physician if any adverse events occur.
25°C (77°F); excursions permitted to 15-30°C (59-86°F).
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