Metformin and Repaglinide

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

  1. alopecia
  2. anaphylactoid reactions
  3. anemia
  4. angina
  5. anorexia
  6. arthralgia
  7. chest pain (unspecified)
  8. cholestasis
  9. diarrhea
  10. dysgeusia
  11. dyspepsia
  12. elevated hepatic enzymes
  13. flatulence
  14. folate deficiency
  15. headache
  16. hemolysis
  17. hemolytic anemia
  18. hepatic failure
  19. hypoglycemia
  20. hypotension
  21. infection
  22. jaundice
  23. lactic acidosis
  24. leukopenia
  25. malaise
  26. megaloblastic anemia
  27. metabolic acidosis
  28. metallic taste
  29. myalgia
  30. nausea
  31. pancreatitis
  32. rhabdomyolysis
  33. secondary failure
  34. sinusitis
  35. Stevens-Johnson syndrome
  36. thrombocytopenia
  37. vitamin B12 deficiency
  38. vomiting
  39. 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

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  • grapefruit juice
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