Prandin (repaglinide) is a rapid-acting, short-duration meglitinide-class oral antidiabetic agent indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It functions by stimulating insulin release from the pancreatic beta cells, specifically targeting postprandial (after-meal) blood glucose excursions. This medication is particularly suitable for patients with irregular meal schedules or those who require flexible dosing aligned with their carbohydrate intake. Prandin is not indicated for the treatment of type 1 diabetes or diabetic ketoacidosis.

Features

• Active Ingredient: Repaglinide
• Drug Class: Meglitinide
• Mechanism of Action: Binds to and closes ATP-sensitive potassium channels on the pancreatic beta-cell membrane, stimulating insulin secretion.
• Onset of Action: Rapid; within 30 minutes of oral administration.
• Duration of Action: Short; approximately 2-4 hours.
• Administration: Oral tablet.
• Available Strengths: 0.5 mg, 1 mg, and 2 mg tablets.

Benefits

• Targets Postprandial Hyperglycemia: Effectively lowers blood glucose spikes that occur after meals, a key contributor to overall glycemic control as measured by HbA1c.
• Dosing Flexibility: Taken with each main meal (2, 3, or 4 times daily), allowing patients to skip a dose if they skip a meal, thereby reducing the risk of between-meal hypoglycemia.
• Rapid Onset and Short Duration: Its pharmacokinetic profile means it acts quickly when needed (at mealtime) and its effects diminish soon after, aligning therapy with the body’s natural postprandial insulin response.
• Adjunctive Therapy Option: Can be used as monotherapy or in combination with other antidiabetic agents like metformin or thiazolidinediones (e.g., pioglitazone) when glycemic targets are not met with a single agent.
• Suitable for Variable Schedules: Ideal for patients with irregular eating patterns or shift work who may struggle with fixed-dose regimens.

Common use

Prandin is commonly prescribed for the management of type 2 diabetes mellitus. It is used when postprandial hyperglycemia is a significant concern and when a flexible, meal-time dependent dosing regimen is preferred. It is often initiated after lifestyle modifications (diet and exercise) alone have proven insufficient. Clinicians may select Prandin for patients who experience hypoglycemia with longer-acting sulfonylureas or for those who require a more tailored approach to mealtime glucose control.

Dosage and direction

• Initial Dose: For patients not previously treated with oral antidiabetic agents or whose HbA1c is <8%, the recommended starting dose is 0.5 mg before each meal.
• Dosing Schedule: Prandin should be taken within 30 minutes before a meal, typically 2, 3, or 4 times daily depending on the number of main meals.
• Titration: The dose may be doubled at weekly intervals based on patient response and blood glucose measurements. The preprandial dose may range from 0.5 mg to 4 mg, with a maximum recommended total daily dose of 16 mg.
• Missed Meal: If a meal is skipped, the dose of Prandin for that meal should be skipped to avoid hypoglycemia.
• Combination Therapy: When used in combination with metformin or a thiazolidinedione, the dose of Prandin should be maintained while the other agent is initiated at its usual starting dose.

Precautions

• Hypoglycemia: Prandin can cause hypoglycemia. Patients must be educated on the recognition, treatment, and prevention of low blood sugar. Renal or hepatic impairment increases this risk.
• Hepatic Impairment: Use with caution in patients with liver disease. Longer intervals between dose adjustments may be required to allow full assessment of response.
• Renal Impairment: Caution is advised in patients with renal impairment. Although Prandin is primarily metabolized by the liver, patients with severe renal impairment may be more susceptible to hypoglycemia.
• Concomitant Illness: Stress from fever, trauma, infection, or surgery may cause a loss of glycemic control, potentially necessitating temporary insulin therapy.
• Macrovascular Outcomes: There is no clinical evidence establishing conclusive evidence of macrovascular risk reduction with Prandin or any other antidiabetic drug.

Contraindications

Prandin is contraindicated in patients with:

• Known hypersensitivity to repaglinide or any inactive ingredient in the formulation.
• Diabetic ketoacidosis, with or without coma. This condition should be treated with insulin.
• Type 1 diabetes mellitus.

Possible side effect

The most common adverse reactions are related to its pharmacologic effect of hypoglycemia.

• Very Common (>10%): Hypoglycemia.
• Common (1% to 10%): Abdominal pain, diarrhea, nausea, vomiting, constipation, arthralgia (joint pain), back pain, headache, upper respiratory tract infection, bronchitis, sinusitis, rhinitis.
• Uncommon (0.1% to 1%): Acute coronary syndrome (e.g., myocardial ischemia), hypersensitivity reactions (e.g., rash, itching, hives), visual disturbances, severe hypoglycemic reactions.
• Rare (<0.1%): Hepatitis, elevated liver enzymes, thrombocytopenia, leukopenia, hemolytic anemia.

Drug interaction

Prandin is metabolized primarily by the liver enzyme CYP2C8 and CYP3A4. Concomitant use with inhibitors or inducers of these enzymes can significantly alter its plasma concentration.

• Contraindicated Interactions:
  • Gemfibrozil: STRONGLY CONTRAINDICATED. Concomitant use increases repaglinide exposure markedly and prolongs its effect, creating a high risk of severe and prolonged hypoglycemia.
• Significant Interactions (Use Contraindicated or Requires Close Monitoring/Dose Adjustment):
  • CYP2C8 Inhibitors (e.g., Clopidogrel, Deferasirox, Teriflunomide): May increase repaglinide levels and risk of hypoglycemia.
  • CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin): May increase repaglinide levels.
  • CYP3A4 Inducers (e.g., Rifampin, Carbamazepine, St. John’s Wort): May decrease repaglinide levels, reducing its efficacy.
  • Beta-blockers: May mask the tachycardic symptoms of hypoglycemia.
  • Other Glucose-Lowering Agents: May increase the risk of hypoglycemia.

Missed dose

If a dose is missed and it is soon after the meal time, the patient may take the dose. However, if the meal has been completed for some time, the dose should be skipped entirely. The patient should not double the next dose to make up for the missed one, as this significantly increases the risk of hypoglycemia. The next dose should be taken at the usual time before the next main meal.

Overdose

An overdose of Prandin will produce pronounced hypoglycemia, presenting as symptoms like dizziness, sweating, tremor, headache, confusion, and can progress to seizures, coma, and death.

• Management: Mild hypoglycemia should be treated with oral glucose (e.g., glucose tablets, fruit juice, regular soft drink). More severe episodes with unconsciousness or seizures require parenteral administration of glucagon or intravenous glucose. Continuous glucose monitoring and carbohydrate intake may be necessary for a prolonged period (12-24 hours or more) due to the extended duration of hypoglycemic effect in an overdose scenario. Hospitalization is often required.

Storage

• Store Prandin tablets at room temperature between 20°C to 25°C (68°F to 77°F).
• Keep the bottle tightly closed to protect from moisture.
• Keep out of reach of children and pets.
• Do not use after the expiration date printed on the bottle.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various medical resources but may not be comprehensive or reflect the most recent medical developments.

Reviews

• “As an endocrinologist, I find Prandin to be an invaluable tool for patients with significant postprandial excursions and erratic schedules. The ability to dose with meals provides a level of control and safety that longer-acting agents cannot match.” – Dr. E. Lawson, MD
• “Clinical trial data consistently shows Prandin’s efficacy in reducing HbA1c, primarily through its targeted effect on post-meal glucose levels. Its safety profile is well-established, with hypoglycemia being the primary concern, as expected from an insulin secretagogue.” – Clinical Pharmacologist Review
• “Switching my patient from glyburide to Prandin resolved his persistent afternoon hypoglycemia. The meal-based dosing aligned perfectly with his lifestyle, and his overall glycemic control improved.” – Diabetes Nurse Practitioner
• “From a pharmacokinetic standpoint, repaglinide’s rapid absorption and short half-life make it a rationally designed agent for mealtime glucose management, minimizing the insulin secretagogue effect during fasting periods.” – Pharmaceutical Sciences Journal