Home Drug Guide Nateglinide

Drug Guide

Generic Name

Nateglinide

Brand Names Starlix

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Meglitinide (Insulin secretagogue)

FDA Approved Indications

  • Type 2 diabetes mellitus, to improve glycemic control

Mechanism of Action

Nateglinide stimulates rapid, short-lived insulin secretion from pancreatic beta cells by closing ATP-dependent potassium channels, thereby lowering blood glucose levels after meals.

Dosage and Administration

Adult: Start with 120 mg orally before meals. Adjust based on response, not exceeding 270 mg per day.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; dose adjustments may be necessary due to renal and hepatic function.

Renal Impairment: Use with caution; monitor for hypoglycemia. Dose adjustment may be needed.

Hepatic Impairment: Use with caution; hepatic metabolism may be impaired, increasing risk of hypoglycemia.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Widely distributed; protein binding approx. 99%.

Metabolism: Primarily hepatic via CYP3A4 and glucuronidation.

Excretion: Primarily fecal; minor renal excretion.

Half Life: Approximately 1 hour for the parent compound.

Contraindications

  • Type 1 diabetes mellitus
  • Diabetic ketoacidosis

Precautions

  • Hepatic impairment, as drug is extensively metabolized by the liver.
  • Risk of hypoglycemia, especially when used with other insulin secretagogues or insulin.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Headache (Uncommon)
  • Back pain (Uncommon)

Adverse Reactions - Serious

  • Severe hypoglycemia (Rare)
  • Allergic reactions, including rash, urticaria (Rare)

Drug-Drug Interactions

  • Sulfonylureas (increased risk of hypoglycemia)
  • Insulin (risk of hypoglycemia)
  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin; may increase nateglinide levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly. Assess for signs of hypoglycemia. Review hepatic function. Evaluate medication adherence.

Diagnoses:

  • Risk for unstable blood glucose levels
  • Risk for hypoglycemia

Implementation: Administer before meals as prescribed. Educate patient on recognizing hypoglycemia symptoms.

Evaluation: Evaluate blood glucose response and adjust dosage accordingly.

Patient/Family Teaching

  • Take medication 1-30 minutes before meals.
  • Report symptoms of hypoglycemia (shakiness, sweating, dizziness).
  • Maintain a consistent diet and meal times.
  • Monitor blood glucose as directed.

Special Considerations

Black Box Warnings:

  • Hypoglycemia risk; particularly when combined with other hypoglycemic agents.
  • Liver function should be monitored periodically.

Genetic Factors: No specific genetic contraindications.

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, including unconsciousness, seizures.

Treatment: Immediate administration of glucose; if unconscious, intravenous dextrose may be necessary. Monitor and support vital signs.

Storage and Handling

Storage: Store at room temperature between 20-25°C (68-77°F). Keep container tightly closed.

Stability: Stable under recommended storage conditions; check expiration date regularly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.