Prandin (repaglinide) is a rapid-acting meglitinide analog oral antidiabetic agent indicated for the management of hyperglycemia in type 2 diabetes mellitus. It functions by stimulating insulin secretion from pancreatic beta cells in a glucose-dependent manner, offering targeted control of postprandial glucose excursions. Prandin is typically prescribed as an adjunct to diet and exercise when glycemic control cannot be achieved through lifestyle modifications alone. Its pharmacokinetic profile allows for flexible dosing in relation to meals, making it a practical option for patients with irregular eating schedules. Clinical evidence supports its efficacy in reducing HbA1c levels while minimizing the risk of prolonged hypoglycemia.

Features

• Active ingredient: Repaglinide (1 mg or 2 mg tablets)
• Rapid onset of action: begins working within 30 minutes of administration
• Short duration of effect: approximately 3–4 hours
• Flexible dosing schedule: taken with each main meal (up to 4 times daily)
• Renal excretion: minimal renal clearance, making it suitable for some patients with renal impairment
• No accumulation: does not accumulate with repeated dosing

Benefits

• Effectively lowers postprandial blood glucose spikes, contributing to overall glycemic stability
• Reduces HbA1c levels by 1.5–2.0% on average when used as monotherapy or in combination
• Flexible meal-time administration accommodates variable eating patterns
• Lower risk of interprandial or nocturnal hypoglycemia compared to longer-acting secretagogues
• Suitable for use in patients with moderate renal impairment (with caution and dose adjustment)
• Can be combined with metformin or other antidiabetic agents for enhanced glycemic control

Common use

Prandin is primarily prescribed for adults with type 2 diabetes mellitus who have not achieved adequate glycemic control through diet, exercise, or other oral antidiabetic agents. It is particularly beneficial for patients who experience significant postprandial hyperglycemia or those with irregular meal patterns. It may be used as monotherapy or in combination with metformin or thiazolidinediones when additional glycemic control is required. Prandin is not indicated for type 1 diabetes or diabetic ketoacidosis.

Dosage and direction

The recommended starting dose is 0.5 mg taken within 30 minutes before each main meal. Dosage may be titrated at weekly intervals based on blood glucose response, up to a maximum of 4 mg per meal or 16 mg per day. Patients should be instructed to skip the dose if a meal is omitted to reduce the risk of hypoglycemia. For patients transferring from other oral hypoglycemic agents, initial dosing should be conservative with close monitoring. Dose adjustment may be necessary in elderly patients or those with hepatic impairment.

Precautions

Patients should be advised to monitor blood glucose regularly, especially during dose titration. Use with caution in patients with hepatic impairment, as repaglinide is extensively metabolized by the liver. Alcohol consumption may increase the risk of hypoglycemia. Prandin may cause dizziness or visual disturbances; patients should avoid driving or operating machinery until they know how the medication affects them. Pregnancy category C: use only if potential benefit justifies potential risk to the fetus.

Contraindications

Hypersensitivity to repaglinide or any component of the formulation. Diabetic ketoacidosis, with or without coma. Type 1 diabetes mellitus. Concomitant use with gemfibrozil or other strong CYP2C8 and CYP3A4 inhibitors due to significantly increased repaglinide exposure and hypoglycemia risk.

Possible side effects

Common adverse reactions (≥5%) include hypoglycemia, upper respiratory infection, headache, and diarrhea. Hypoglycemia is the most frequently reported side effect, with symptoms including dizziness, sweating, tremor, and palpitations. Less common effects include arthralgia, back pain, and nausea. Severe hypoglycemia requiring assistance is rare but possible, particularly with missed meals, excessive dosing, or concomitant use of other glucose-lowering agents.

Drug interaction

Strong CYP2C8 inhibitors (e.g., gemfibrozil) contraindicated due to 8-fold increase in repaglinide exposure. CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase repaglinide levels. Inducers of CYP3A4 (e.g., rifampin) may decrease efficacy. Beta-blockers may mask hypoglycemia symptoms. NSAIDs, salicylates, and other protein-bound drugs may potentiate hypoglycemic effects. Concurrent use with other antidiabetic agents increases hypoglycemia risk.

Missed dose

If a dose is missed and the next meal is more than 30 minutes away, the missed dose should be omitted. Do not double the dose to make up for a missed administration. Patients should check blood glucose levels if unsure about dosing timing.

Overdose

Symptoms are consistent with hypoglycemia and may include sweating, tremor, dizziness, hunger, confusion, and tachycardia. Severe overdose may lead to seizures, coma, or neurological impairment. Treatment involves immediate glucose administration (oral or intravenous depending on severity) and continuous glucose monitoring. Dialysis is not effective due to high protein binding.

Storage

Store at room temperature (20–25°C/68–77°F) in the original container. Protect from moisture and light. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and does not replace professional medical advice. Dosage and administration should be determined by a qualified healthcare provider based on individual patient needs. Patients should not adjust or discontinue medication without consulting their physician.

Reviews

Clinical studies demonstrate Prandin’s efficacy in reducing HbA1c by 1.5–2.0% with a favorable safety profile. In a 1-year multicenter trial, 72% of patients achieved HbA1c <7% with repaglinide monotherapy. Post-marketing surveillance confirms the low incidence of severe hypoglycemia (0.01–0.03 events/patient-year). Patient satisfaction surveys note appreciation for meal-time flexibility compared to fixed-dose regimens.