nateglinide: clinical use

Prescribing considerations

• Use only with metformin for the licensed indication; the selected product is not licensed for monotherapy.
• Assess hypoglycaemia susceptibility, particularly in older, malnourished or debilitated people and those with adrenal, pituitary or severe renal impairment.
• Clinical experience in children, adolescents and the very elderly is limited or absent.
• Intercurrent infection, fever, trauma or surgery may destabilise glycaemic control.
• The tablets contain lactose.

Contraindications and cautions

• Hypersensitivity to nateglinide or an excipient
• Type 1 diabetes
• Diabetic ketoacidosis, with or without coma
• Pregnancy
• Breastfeeding
• Severe hepatic impairment

Monitoring

• Monitor HbA1c periodically and consider post-meal glucose because the main therapeutic effect is on mealtime glucose.
• Review hypoglycaemia frequency and awareness, including implications for driving.
• Observe glycaemic control when interacting medicines are introduced or withdrawn.
• Use caution in moderate hepatic impairment and reassess patients with severe renal impairment if hypoglycaemic effects are potentiated.

Clinical pharmacology

Nateglinide is a rapid, short-acting, glucose-sensitive insulin secretagogue dependent on functioning pancreatic beta cells. It is rapidly absorbed, highly protein-bound and metabolised mainly by CYP2C9, with a smaller CYP3A4 contribution.

Formulation and product differences

• The selected range consists of film-coated tablets distinguished by colour and shape: pink round, yellow ovaloid and red ovaloid.
• All selected tablet formulations contain lactose monohydrate.