Meglitinides for type 2 diabetes

Examples

Generic Name	Brand Name
nateglinide	Starlix
repaglinide	Prandin
repaglinide and metformin	Prandimet

Nateglinide (Starlix), repaglinide (Prandin), and the combination medicine repaglinide and metformin (Prandimet) help stop the rapid rise in blood sugar levels that can occur immediately after a person with type 2 diabetes eats.

How It Works

Meglitinides prevent a rise in blood sugar levels by increasing the amount of insulin produced by the pancreas, similar to the way sulfonylurea medications work.

Why It Is Used

Meglitinides can be used to treat type 2 diabetes in people whose blood sugar levels have not stayed within a normal or near-normal range using diet and exercise.

Meglitinides can be used along with metformin if diet, exercise, and metformin or repaglinide alone have not kept blood sugar levels within a target range. The dose of each may need to be adjusted to prevent low blood sugar.

Because meglitinides work quickly and do not stay in the body long, they need to be taken at or just before each meal. This allows flexibility for people who do not eat on the same schedule each day.

People who have liver problems may not be able to take repaglinide. In addition, it is unknown whether the medication is safe for use during pregnancy.

How Well It Works

Repaglinide has been found to be safe and effective in adults who have type 2 diabetes. Some older adults may be more sensitive to side effects.

One study found that repaglinide was as safe and effective as glyburide (one of the sulfonylurea medications) in treating people with type 2 diabetes.¹

Repaglinide has not been studied in children or pregnant or nursing women.

Side Effects

Side effects of repaglinide are similar to those of sulfonylurea medications and include:

• Low blood sugar.
• Upper respiratory infections, nasal and sinus inflammation, and bronchitis.
• Joint pain.
• Nausea.
• Weight gain.

While repaglinide may cause low blood sugar and weight gain, these side effects are milder than in those people who take glyburide.²

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Repaglinide should only be taken just before or during a meal. It can cause low blood sugar if you do not eat right away. If you miss a meal, do not take that dose of medication. If you eat an extra meal, add a dose for that meal.

Repaglinide acts quickly, so take it before you start eating or with your first few bites of food. It will have the greatest effect within 30 minutes to an hour, and it will work for about 3 hours.

If you have kidney or liver disease, you may not be able to take these medications. Talk with your health professional.

Children

Few studies have been done on the use of oral medications for type 2 diabetes in children, and these medications have not been approved by the U.S. Food and Drug Administration (FDA) for use in children. But because these oral medications are safe for adults, most health professionals use them to treat children with type 2 diabetes.

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Author:	Caroline Rea, RN, BS, MS	Last Updated: June 16, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism
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