Home Drug Guide Repaglinide

Drug Guide

Generic Name

Repaglinide

Brand Names Prandin

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Insulin secretagogue (meglitinide class)

FDA Approved Indications

  • Management of type 2 diabetes mellitus to improve glycemic control

Mechanism of Action

Repaglinide stimulates rapid insulin release from pancreatic beta cells by closing ATP-dependent potassium channels, leading to cell depolarization and insulin secretion, thus lowering blood glucose levels.

Dosage and Administration

Adult: Initially 0.5 mg before each meal. Adjust based on response, up to 4 mg per dose.

Pediatric: Not recommended for pediatric use.

Geriatric: Start with lower dose due to potential for increased sensitivity. Monitor closely.

Renal Impairment: Use with caution; starting dose may be lower and titrated carefully.

Hepatic Impairment: Use with caution; dose adjustments may be necessary due to altered metabolism.

Pharmacokinetics

Absorption: Rapidly absorbed with peak concentrations in approximately 1 hour after dosing.

Distribution: Extensively plasma protein-bound.

Metabolism: Primarily metabolized in the liver via CYP3A4 and CYP2C8 pathways.

Excretion: Excreted mainly in feces; minimal renal excretion.

Half Life: Approximately 1 hour; however, its pharmacodynamic effect lasts longer due to insulin secretion.

Contraindications

  • Type 1 diabetes mellitus
  • Diabetic ketoacidosis

Precautions

  • Use with caution in hepatic impairment, and in patients with a history of hypoglycemia. Monitor for hypoglycemia, especially in the elderly.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Headache (Less common)
  • Back pain (Less common)

Adverse Reactions - Serious

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

Drug-Drug Interactions

  • Carbamazepine (may decrease effectiveness)
  • Gemfibrozil (may increase plasma levels)
  • Certain antibiotics and antifungals that inhibit CYP3A4

Drug-Food Interactions

  • Alcohol (can potentiate hypoglycemia)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose regularly, especially in initial dose adjustment.

Diagnoses:

  • Risk for hypoglycemia
  • Ineffective tissue perfusion related to hypoglycemia

Implementation: Administer before meals; educate patients to recognize hypoglycemia symptoms.

Evaluation: Assess blood glucose levels to ensure adequate control and absence of hypoglycemia.

Patient/Family Teaching

  • Take medication before meals as directed.
  • Recognize symptoms of hypoglycemia and how to treat it.
  • Maintain regular meal schedule.
  • Avoid alcohol and excessive exercise without prior consultation.

Special Considerations

Black Box Warnings:

  • None specific, but caution advised due to risk of hypoglycemia.

Genetic Factors: Variations in CYP2C8 may affect drug metabolism.

Lab Test Interference: May falsely elevate some laboratory tests, monitor blood glucose levels directly.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, which can cause confusion, seizure, loss of consciousness, or coma.

Treatment: Administer glucose orally or intravenously; if drinking is possible, give fast-acting carbohydrate. In severe cases, administer glucagon or dextrose infusion under medical supervision.

Storage and Handling

Storage: Store at controlled room temperature, away from moisture and light.

Stability: Stable for designated shelf life when stored appropriately.

🛡️ 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.