Metformin and Repaglinide Brand Name– PrandiMet
What is Metformin and Repaglinide
Metformin and repaglinide is a combination antidiabetic product containing a meglitinide (repaglinide), with metformin, a biguanide agent.
The combination product is used as an adjunct to diet and exercise to lower blood glucose concentrations in adult patients with type 2 diabetes mellitus (DM).
In patients not adequately controlled on metformin monotherapy, the addition of repaglinide resulted in a significant improvement in A1C and fasting plasma glucose versus the use of either drug alone; the A1C decreased by 1.4% in patients taking combination therapy vs. 0.4% with repaglinide monotherapy and 0.3% with metformin monotherapy (p less than 0.05).
Fasting plasma glucose decreased by 39 mg/dL in patients taking combination therapy vs. an increase of 9 mg/dL with repaglinide monotherapy and a decrease of 5 mg/dL with metformin monotherapy (p less than 0.05).
The risk of lactic acidosis due to metformin is low but requires care in prescribing and monitoring, as indicated by the boxed warning in the product label.
Metformin is first-line in the treatment of type 2 DM. In patients with established cardiovascular (CV) disease, heart failure (HF), or chronic kidney disease (CKD), a sodium-glucose co-transporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with proven CV benefit and reduction of CKD progression is recommended for add-on therapy, independent of baseline A1C or individualized A1C target.
In patients without indicators of high-risk or established CVD, HF, or CKD, repaglinide is an option that has a neutral impact on CV health and HF.
The various meglitinide agents are considered therapeutically similar in clinical use.
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus uncontrolled by diet and exercise
Side Effects
- alopecia
- anaphylactoid reactions
- anemia
- angina
- anorexia
- arthralgia
- chest pain (unspecified)
- cholestasis
- diarrhea
- dysgeusia
- dyspepsia
- elevated hepatic enzymes
- flatulence
- folate deficiency
- headache
- hemolysis
- hemolytic anemia
- hepatic failure
- hypoglycemia
- hypotension
- infection
- jaundice
- lactic acidosis
- leukopenia
- malaise
- megaloblastic anemia
- metabolic acidosis
- metallic taste
- myalgia
- nausea
- pancreatitis
- rhabdomyolysis
- secondary failure
- sinusitis
- Stevens-Johnson syndrome
- thrombocytopenia
- vitamin B12 deficiency
- vomiting
- weight gain
Monitoring Parameters
- blood glucose
- CBC
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- serum creatinine/BUN
Contraindications
- acidemia
- acute heart failure
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- breast-feeding
- burns
- cardiac disease
- cardiogenic shock
- children
- dehydration
- diabetic ketoacidosis
- diarrhea
- ethanol ingestion
- ethanol intoxication
- fever
- gastroparesis
- geriatric
- GI obstruction
- heart failure
- hepatic disease
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypothyroidism
- hypoxemia
- ileus
- infection
- lactic acidosis
- malnutrition
- metabolic acidosis
- pernicious anemia
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- radiographic contrast administration
- renal disease
- renal failure
- renal impairment
- sepsis
- surgery
- trauma
- type 1 diabetes mellitus
- vomiting
Interactions
- Abacavir; Dolutegravir; Lamivudine
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