Prandin: Rapid Postprandial Glucose Control for Type 2 Diabetes
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| Product dosage: 2mg | |||
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Synonyms | |||
Prandin (repaglinide) is a rapid-acting, short-duration meglitinide-class oral antidiabetic agent indicated for the management of hyperglycemia in type 2 diabetes mellitus. It functions as an insulin secretagogue, stimulating the release of insulin from functional pancreatic beta cells in response to meals. This agent is particularly suited for individuals who experience significant postprandial glucose excursions and require flexible meal scheduling. Prandin is designed to be taken with main meals, offering a targeted approach to mealtime glucose control as part of a comprehensive diabetes management plan that includes diet and exercise.
Features
- Active Ingredient: Repaglinide
- Pharmacologic Class: Meglitinide derivative
- 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.
- Bioavailability: Approximately 56%.
- Protein Binding: Greater than 98%.
- Metabolism: Extensively metabolized in the liver by the CYP3A4 enzyme system.
- Elimination: Primarily excreted via the bile into feces; less than 8% is renally excreted.
- Half-life: Approximately 1 hour.
Benefits
- Targeted Mealtime Control: Effectively lowers blood glucose spikes that occur after eating (postprandial hyperglycemia).
- Flexible Dosing: Taken at the start of each main meal, allowing for dose adjustment or omission based on meal intake, which supports an adaptable lifestyle.
- Reduced Hypoglycemia Risk Between Meals: Its short duration of action minimizes the risk of hypoglycemia later in the day or overnight compared to longer-acting secretagogues.
- Complementary Therapy: Can be used as monotherapy or in combination with other antidiabetic agents like metformin or thiazolidinediones to achieve comprehensive glycemic control.
- Rapid Onset: Begins working quickly to mimic the body’s natural mealtime insulin response.
Common use
Prandin is commonly prescribed for the management of type 2 diabetes mellitus in adult patients. It is used when glycemic control has not been achieved through diet, exercise, or other medications alone. Its primary role is to address postprandial (after-meal) hyperglycemia. It is often selected for patients with irregular meal schedules or those who are prone to hypoglycemia at times distant from meals. Prandin may be used as a first-line agent or as an add-on therapy to metformin.
Dosage and direction
The dosage of Prandin must be individualized based on the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goals.
- Initial Dose: For patients not previously treated with oral hypoglycemic agents or whose HbA1c is <8%, the recommended starting dose is 0.5 mg before each meal.
- Titration: The dose may be doubled at weekly intervals until adequate glycemic control is achieved. The preprandial dose can range from 0.5 mg to 4 mg, taken with meals.
- Dosing Schedule: Prandin should be taken within 30 minutes before starting a meal (2 to 30 minutes preprandial). It is typically administered two, three, or four times daily, corresponding to the number of main meals. A dose should be omitted if a meal is skipped.
- Maximum Recommended Dose: The maximum recommended single dose is 4 mg. The maximum total daily dose should not exceed 16 mg.
- Combination Therapy: When used in combination with metformin or a thiazolidinedione, the current dose of Prandin should be maintained, and the new agent should be initiated at its recommended starting dose. Subsequent adjustment should be based on blood glucose response.
Precautions
- Hypoglycemia: Prandin can cause hypoglycemia. The risk is increased by skipped meals, alcohol, strenuous exercise, other antidiabetic drugs, and impaired renal or hepatic function. Patients must be educated to recognize and manage hypoglycemia.
- Hepatic Impairment: Use with caution in patients with liver disease. Repaglinide is extensively metabolized in the liver. Patients with impaired liver function may be exposed to higher concentrations of the drug, increasing the risk of hypoglycemia. Consider longer intervals between dose adjustments.
- Renal Impairment: Although primarily excreted via the liver, caution is advised in patients with renal impairment. Patients with type 2 diabetes who have severe renal function impairment should initiate therapy with the 0.5 mg dose.
- Loss of Glycemic Control: In patients exposed to stress such as fever, trauma, infection, or surgery, a loss of glycemic control may occur. Temporary insulin therapy may be required.
- Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Prandin or any other oral antidiabetic drug.
Contraindications
Prandin is contraindicated in patients with:
- Known hypersensitivity to repaglinide or any of the product’s inactive ingredients.
- 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 (>5%) are hypoglycemia and upper respiratory tract infection. Other potential side effects include:
- Very Common (>10%): Hypoglycemia.
- Common (1% to 10%): Abdominal pain, diarrhea, arthralgia, back pain, bronchitis, chest infection, constipation, dyspepsia, nausea, vomiting, paresthesia, visual disturbance, hypertension, angina pectoris, cardiac ischemia.
- Uncommon (0.1% to 1%): Hypersensitivity reactions, pancreatitis, atrial fibrillation, thrombocytopenia, leukopenia, allergic skin reactions, severe hypoglycemic reactions.
- Rare (<0.1%): Hepatic dysfunction, including elevated liver enzymes and hepatitis.
Drug interaction
Prandin is metabolized by the CYP3A4 enzyme system in the liver. Concomitant use of drugs that induce or inhibit this system can significantly alter its plasma concentration.
- Contraindicated Interactions:
- Gemfibrozil: STRONGLY CONTRAINDICATED. Concomitant use increases repaglinide exposure and significantly enhances and prolongs its hypoglycemic effect. This combination must be avoided.
- Interactions Requiring Close Monitoring/Dose Adjustment:
- CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, erythromycin): May increase repaglinide plasma levels, increasing the risk of hypoglycemia. Blood glucose should be monitored closely and a Prandin dose reduction may be necessary.
- CYP3A4 Inducers (e.g., rifampin, phenytoin, barbiturates, carbamazepine): May decrease repaglinide plasma levels, leading to reduced efficacy and hyperglycemia. Blood glucose should be monitored closely and a Prandin dose increase may be necessary.
- Other Glucose-Lowering Agents (e.g., metformin, thiazolidinediones, insulin): May increase the risk of hypoglycemia.
- Beta-blockers: May mask the signs and symptoms of hypoglycemia (e.g., tachycardia).
- NSAIDs, Salicylates, Sulfonamides, MAOIs: May enhance the hypoglycemic effect of repaglinide.
Missed dose
If a dose is missed and it is soon after the meal was started, the patient should take the dose immediately. If the meal has been completed, the missed dose should be skipped. The patient should not double the next dose to make up for a missed one, as this increases the risk of hypoglycemia.
Overdose
- Manifestation: Overdose of Prandin will likely result in severe and prolonged hypoglycemia, presenting as symptoms like dizziness, confusion, tremors, sweating, and coma.
- Management: Mild hypoglycemia can often be treated with oral carbohydrates. More severe episodes with coma, seizure, or other neurological impairment require immediate medical attention. Administer intravenous glucose (50% solution) or intramuscular glucagon. Continuous glucose infusion and frequent monitoring may be required for a prolonged period (24-48 hours) due to the drug’s duration of action. Hemodialysis is not effective due to Prandin’s high protein binding.
Storage
- Store Prandin tablets at a controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).
- Keep the bottle tightly closed to protect from moisture.
- Keep out of reach of children.
- Safely discard any unused medication after the expiration date.
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 information provided is not exhaustive and may not cover all possible uses, directions, precautions, interactions, or adverse effects.
Reviews
- “As an endocrinologist, I find Prandin to be an invaluable tool for patients with significant postprandial excursions and erratic schedules. The flexibility it offers is a major advantage over longer-acting sulfonylureas, and the side effect profile is generally manageable with proper patient education.” – Dr. E. Vance, MD, Endocrinology
- “Starting on Prandin was a game-changer for my glucose control after meals. I appreciate that I only take it when I eat, which gives me peace of mind on days I’m not very hungry. My HbA1c has improved significantly.” – Patient T.S.
- “From a clinical pharmacy perspective, Prandin’s drug interaction profile, particularly the absolute contraindication with gemfibrozil, requires vigilant medication reconciliation. However, when used appropriately in the right patient population, it is a highly effective agent for targeted glycemic management.” – Clinical Pharmacist Review
- “I’ve been on it for two years alongside metformin. It works very well, but you have to be disciplined about taking it right before you eat. I learned the hard way that taking it too early can lead to a low.” – Patient R.K.