- ACRONYMS AND DEFINITIONS
- CrCl - Creatinine clearance
- HgA1C - Hemoglobin A1C
- MEGLITINIDES
Nateglinide (Starlix®)
Dosage forms
Tablet
- 60 mg
- 120 mg
Dosing
Type 2 diabetes
- Dosing: 120 mg three times a day before meals
- Max: 120 mg three times a day before meals
- 60 mg dose may be used in patients close to A1C goals
- Take 1 - 30 minutes prior to a meal
Generic / Price
- YES/$$Repaglinide (Prandin®)
Dosage forms
Tablet
- 0.5 mg
- 1 mg
- 2 mg
Dosing
Type 2 diabetes
- Starting
- HgA1C < 8%
- 0.5 mg before each meal
- HgA1C ≥ 8%
- 1 - 2 mg before each meal
- Maintenance
- 0.5 - 4 mg with each meal
- Increase dose at intervals of ≥ 1 week
- Do not exceed 16 mg/day
- Increase dose by doubling current dose
- May be given up to 4 times a day
- Do not give dose if meal is skipped
- Take within 30 minutes before meals
Generic / Price
- YES/$PrandiMet® (repaglinide + metformin)
Dosage forms
Tablet
- Repaglinide - Metformin
- 1 mg - 500 mg
- 2 mg - 500 mg
Dosing
Type 2 diabetes
- Starting: 1/500 mg twice daily with meals
- Max: repaglinide 10 mg/day; metformin 2500 mg/day
- May be given two to three times a day
- No more than 4 mg repaglinide or 1000 mg metformin should be taken per meal
- Ideally taken 15 minutes prior to a meal, but can vary from 0 - 30 minutes
Generic / Price
- YES/$$$$Other
- If meal is skipped, do not take dose
- Kidney disease dosing
- Nateglinide (Starlix®)
- No adjustment is necessary in mild-to-severe kidney disease [2]
- Repaglinide (Prandin®)
- CrCl > 40 ml/min: no adjustment necessary
- CrCl 20 - 40 ml/min: start therapy at 0.5 mg dose, titrate slowly
- CrCl < 20 ml/min: - has not been studied [1]
- Liver disease dosing
- Nateglinide (Starlix®)
- Nateglinide has not been studied in patients with moderate-to-severe liver disease
- Nateglinide should be used with caution in these patients [2]
- Repaglinide (Prandin®)
- Repaglinide should be used with caution in patients with moderate-to-severe liver disease
- In studies, repaglinide levels have been increased in patients with moderate-to-severe liver disease
- Manufacturer states that dosage adjustments will be necessary, but gives no specific recommendations [1]
- DRUG INTERACTIONS
- NOTE: Drug interactions presented here are NOT all-inclusive. Other interactions may exist. The interactions presented here are meant to encompass commonly prescribed medications and/or interactions that are well-documented. Always consult your physician or pharmacist before taking medications concurrently. CLICK HERE for more information on drug interactions.
- Nateglinide (Starlix®)
- CYP2C9 inhibitors and inducers - nateglinide is a CYP2C9 sensitive substrate. CYP2C9 inhibitors and inducers may affect exposure to nateglinide.
- Repaglinide (Prandin®)
- Clopidogrel (Plavix®)
- The acyl-β-glucuronide metabolite of clopidogrel is a CYP2C8 strong inhibitor
- Repaglinide is a sensitive CYP2C8 substrate. Clopidogrel increases repaglinide exposure by 4 - 5 fold.
- Repaglinide should not be given with clopidogrel
- If concomitant use cannot be avoided, initiate repaglinide at a dose of 0.5 mg before each meal and titrate based on blood sugars. Do not exceed 4 mg/day.
- When clopidogrel is added to repaglinide, repaglinide doses should be reduced to no more than 4 mg/day [8]
- Cyclosporine - Cyclosporine increases repaglinide levels. Do not exceed 6 mg/day of repaglinide if given concomitantly.
- CYP3A inducers and inhibitors - CYP3A inducers and inhibitors may affect repaglinide blood levels. Dose adjustments may be necessary.
- CYP2C8 inducers and inhibitors - CYP2C8 inducers and inhibitors may affect repaglinide blood levels. Dose adjustments may be necessary.
- Gemfibrozil (Lopid®) - DO NOT COMBINE. Gemfibrozil may increase repaglinide levels and they should not be taken together
- OATP inhibitors - OATP inhibitors may affect repaglinide blood levels
- Metabolism and clearance
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $150
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- 1 - Repaglinide PI
- 2 - Nateglinide PI