Hypoglycemia repaglinide

Patient management Monitor long-term efficacy by measurement of HbA- c levels approximately every 3 months. When hypoglycemia occurs in patients taking a combination of repaglinide and a thiazolidinedione or repaglinide and metformin, reduce the dose of repaglinide. 

Lactation It is not known whether repaglinide is excreted in breast milk. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made as to whether repaglinide should be discontinued in nursing mothers, or if mothers should discontinue nursing. 

Hypoglycemia Hepatic insufficiency may cause elevated repaglinide blood levels... 

Repaglinide is metabolized in the liver with an elimination half-life of 1 hour. Also its adverse reaction profile is very similar to that of the sulfony-lureas, i.e. apart from hypoglycemia, gastrointestinal complaints and skin reactions. 

In 424 patients in a European multicenter, randomized, double-blind study for 1 year, two-thirds of the patients used repaglinide (0.5—4 mg tds) and the others glibencla-mide (1.75-10.5 mg/day) (19). I IbAlc first fell but later increased. The same trends were seen in fasting blood glucose. There were no differences in hypoglycemia. A comparable American study of 576 patients (20) showed essentially the same result. 

In a multicenter, double-blind, randomized, fixed-dose trial of placebo and repaglinide 1 mg and 4 mg for 24 weeks in 361 patients there were no episodes of severe hypoglycemia (28). Most patients withdrew from the placebo group because of hyperglycemia, hypoglycemia, erythematous rash, headache, diarrhea, fatigue, or abnormal vision. Adverse effects had about the same frequencies in the two groups. 

Clarithromycin, an inhibitor of CYP3A4, increases the plasma concentrations and the effect of repaglinide this can enhance the blood glucose lowering effect and increase the risk of hypoglycemia (59). 

Hirshberg B, Skarulis MC, Pucino F, Csako G, Brennan R, Gorden P. Repaglinide-induced factitious hypoglycemia. J Clin Endocrinol Metab 2001 86(2) 475-7. 

Benzoic acid derivatives Repaglinide (Prandin) Nateglinide (Starlix) Similar to the sulfonylureas Hypoglycemia bronchitis upper respiratory tract infections joint and back pain gastrointestinal disturbances headache... 

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