repaglinide: clinical use

Prescribing considerations

• Licensed for adults; safety and efficacy below age 18 are not established, and clinical study evidence above age 75 is lacking.
• Assess hypoglycaemia risk, meal pattern, nutrition, renal and hepatic status, and interacting medicines.
• Acute illness, infection, trauma or surgery can destabilise glycaemic control and may require temporary treatment review.
• Combining repaglinide with metformin increases hypoglycaemia risk.
• The SmPC notes a possible association with increased acute coronary syndrome incidence.

Contraindications and cautions

• Hypersensitivity to repaglinide or an excipient
• Type 1 diabetes
• Diabetic ketoacidosis, with or without coma
• Severe hepatic impairment
• Concurrent gemfibrozil

Monitoring

• Periodic blood glucose and glycated haemoglobin to assess response and detect primary or secondary failure
• Frequency and severity of hypoglycaemia
• Close glucose and clinical monitoring when relevant interacting treatments are started or stopped

Clinical pharmacology

Repaglinide is rapidly absorbed and highly protein bound. It is metabolised mainly by CYP2C8, with a smaller CYP3A4 contribution, and is also an OATP1B1 substrate. It has a short plasma half-life and its metabolites are cleared mainly through bile.

Formulation and product differences

• The selected product is a pink, marbled, round, biconvex tablet with bevelled edges and possible darker spots.
• It is considered essentially sodium-free.
• Excipients include croscarmellose sodium, povidone, glycerol, meglumine, poloxamer and red iron oxide.

Tablet

Route: Oral

Strengths: 0.5 mg, 1 mg, 2 mg