Starlix: Advanced Postprandial Glucose Control for Type 2 Diabetes
| Product dosage: 120mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $1.33 | $40.04 (0%) | 🛒 Add to cart |
| 60 | $1.12 | $80.08 $67.07 (16%) | 🛒 Add to cart |
| 90 | $1.05 | $120.12 $94.09 (22%) | 🛒 Add to cart |
| 120 | $1.00 | $160.16 $120.12 (25%) | 🛒 Add to cart |
| 180 | $0.96 | $240.24 $173.17 (28%) | 🛒 Add to cart |
| 270 | $0.90 | $360.36 $243.24 (32%) | 🛒 Add to cart |
| 360 | $0.80
Best per pill | $480.48 $288.29 (40%) | 🛒 Add to cart |
Synonyms | |||
Starlix (nateglinide) is a rapid-acting insulin secretagogue specifically engineered to address postprandial hyperglycemia in patients with type 2 diabetes mellitus. By stimulating early-phase insulin secretion from pancreatic beta cells, it provides a targeted physiological response to meal ingestion. This mechanism offers a critical therapeutic advantage in managing the sharp glucose excursions that contribute significantly to overall glycemic burden and long-term diabetic complications. Its pharmacokinetic profile allows for flexible dosing aligned with meal patterns, making it a valuable option for individuals seeking precise post-meal glucose management.
Features
- Active pharmaceutical ingredient: Nateglinide
- Available in 60 mg and 120 mg oral tablets
- Rapid onset of action, typically within 20 minutes of administration
- Short duration of effect, minimizing interprandial insulin secretion
- Metabolized primarily in the liver via CYP2C9 and CYP3A4 enzymes
- Excreted predominantly in urine (approximately 85%) with a minor fecal component
- Plasma half-life of approximately 1.5 hours
- White, round, film-coated tablets with distinct markings for strength identification
Benefits
- Significantly reduces postprandial glucose spikes, lowering the 2-hour PPG average by 40-60 mg/dL in clinical studies
- Minimizes risk of prolonged hyperinsulinemia and subsequent hypoglycemia between meals due to its short-acting profile
- Provides dosing flexibility, as it can be taken immediately before each main meal (up to three times daily), accommodating variable eating schedules
- Demonstrates a lower incidence of severe hypoglycemia compared to longer-acting sulfonylureas when used as monotherapy
- Can be effectively combined with metformin or other insulin sensitizers for enhanced glycemic control without significant pharmacokinetic interactions
- Shows particular efficacy in patients with relatively preserved beta-cell function, making it suitable for early-stage type 2 diabetes management
Common use
Starlix is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is most commonly prescribed for patients who experience significant postprandial glucose excursions despite lifestyle modifications. Clinicians often select nateglinide for individuals with irregular meal patterns or those who require targeted prandial glucose management without the prolonged insulin stimulation characteristic of sulfonylureas. It may be used as monotherapy or in combination with metformin when dual therapy is required to achieve hemoglobin A1c targets. The medication is particularly suitable for patients with renal impairment (though dosage adjustment may be necessary) due to its predominantly hepatic metabolism.
Dosage and direction
The recommended starting dose for treatment-naïve patients is 120 mg three times daily, taken 1-30 minutes before each main meal. For patients nearing glycemic targets or those with mild hyperglycemia, an initial dose of 60 mg three times daily may be appropriate. Dosing should be individualized based on glycemic response, tolerance, and meal patterns—if a meal is skipped, the corresponding dose should be omitted. The maximum recommended daily dose is 360 mg (three 120 mg tablets). For patients transitioning from other oral hypoglycemic agents, discontinue the previous medication and initiate Starlix at 120 mg before meals. Dosage adjustment is recommended in patients with moderate to severe hepatic impairment, though no specific adjustment is required for renal impairment. Efficacy should be assessed through periodic hemoglobin A1c measurements and self-monitored blood glucose, particularly 2-hour postprandial readings.
Precautions
Patients should be advised that Starlix is not a substitute for standard dietary management or physical activity. Regular monitoring of blood glucose is essential to identify inadequate response or need for dosage adjustment. Hepatic function should be assessed periodically, as impaired liver function may reduce drug metabolism and increase hypoglycemia risk. Elderly patients (≥65 years) may be more susceptible to hypoglycemia and should be monitored closely. Use with caution in patients with gastrointestinal disorders that might affect drug absorption. Patients should be educated to recognize and manage hypoglycemia symptoms (sweating, tremor, palpitations, hunger). Starlix has not been studied in patients with type 1 diabetes or diabetic ketoacidosis and is not indicated for these conditions. As with any diabetes medication, periodic evaluation of renal function is recommended.
Contraindications
Starlix is contraindicated in patients with known hypersensitivity to nateglinide or any component of the formulation. It must not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Concomitant use with gemfibrozil is contraindicated due to significant interaction that increases nateglinide exposure. The medication is contraindicated in patients with severe hepatic impairment (Child-Pugh Class C) due to insufficient safety data. It should not be used during pregnancy unless clearly necessary, as adequate human data is lacking—insulin remains the preferred therapy for glycemic control during pregnancy. Nursing mothers should discontinue either nursing or Starlix, as it is unknown whether nateglinide is excreted in human milk.
Possible side effects
The most common adverse reaction is hypoglycemia, occurring in approximately 2-5% of patients in clinical trials, typically mild to moderate in severity. Upper respiratory tract infections (4-7%) and flu-like symptoms (3-5%) have been reported at frequencies similar to placebo. Gastrointestinal effects including diarrhea (3%), nausea (2%), and abdominal pain (1%) may occur. dizziness (2-3%) and arthralgia (2%) have been observed. Elevated liver enzymes (ALT, AST) have been reported in <1% of patients. Rare cases of allergic reactions including rash, itching, and urticaria (<0.1%) have been documented. Transient visual disturbances have been reported in association with rapid glucose changes. Although not reported with nateglinide specifically, other insulin secretagogues have been associated with hemolytic anemia in patients with glucose-6-phosphate dehydrogenase deficiency.
Drug interaction
Strong CYP2C9 inhibitors (e.g., fluconazole, amiodarone) may increase nateglinide exposure and hypoglycemia risk—consider dose reduction. Gemfibrozil is contraindicated due to potent inhibition of nateglinide metabolism. CYP2C9 inducers (e.g., rifampin) may decrease nateglinide efficacy. Non-selective beta-blockers may mask hypoglycemia symptoms. Concomitant use with other glucose-lowering agents (insulin, sulfonylureas) increases hypoglycemia risk. NSAIDs, salicylates, sulfonamides, and monoamine oxidase inhibitors may potentiate hypoglycemic effects. Thiazide diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid may reduce hypoglycemic effectiveness. Alcohol may either potentiate or reduce the hypoglycemic effect of nateglinide.
Missed dose
If a dose is missed before a meal, it should be omitted entirely. The patient should take the next scheduled dose before the subsequent meal. Patients should never double the dose to make up for a missed administration. If a meal is skipped or delayed, the corresponding dose should be skipped. This dosing strategy aligns with the medication’s mechanism of targeting postprandial glucose excursions specifically.
Overdose
Symptoms of overdose would be expected to manifest as severe hypoglycemia, including sweating, tremor, tachycardia, hunger, confusion, visual disturbances, somnolence, loss of consciousness, and seizures. Management should include immediate blood glucose measurement and administration of oral glucose for conscious patients. For unconscious patients, administer intravenous glucose (50% dextrose solution) or intramuscular glucagon. Close monitoring and supportive care are essential, as hypoglycemia may recur after initial treatment. Hemodialysis is unlikely to be beneficial due to Starlix’s high protein binding (98%) and extensive metabolism. Hospital observation for at least 24-48 hours is recommended for significant overdoses.
Storage
Store at controlled room temperature 20-25°C (68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children. Do not use tablets that are discolored or show signs of deterioration. Properly discard any unused medication after the expiration date printed on the packaging. Do not flush medications down the toilet or pour into a drain unless instructed to do so.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for specific dosage recommendations and treatment guidance. While every effort has been made to ensure accuracy, medical knowledge evolves rapidly, and healthcare providers should reference the most current prescribing information. Patients should not alter their treatment regimen without consulting their healthcare provider.
Reviews
Clinical trials demonstrate that Starlix effectively reduces hemoglobin A1c by 0.5-1.5% when used as monotherapy, with more significant reductions when combined with metformin. In a 24-week study involving 701 patients, the 120 mg tid dosage produced mean HbA1c reductions of 0.5% compared to placebo. Postprandial glucose reductions of 40-65 mg/dL were consistently observed across multiple trials. Patients report appreciation for the flexible dosing schedule that accommodates variable meal patterns. Healthcare providers note its particular utility in targeting postprandial hyperglycemia without causing significant interprandial hypoglycemia. Some clinicians reserve its use for patients with specific meal-related glucose patterns rather than as first-line therapy. The medication generally receives positive evaluations for its targeted mechanism and favorable safety profile, though its niche application means it is not appropriate for all type 2 diabetes patients.