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REPAGLINIDE: It is a novel insulin secreatagogue which acy by loweing of post prandial blood glucose as well as fasting blood glcose in patients with type 2 diabetes mellitus by acting n the beta cells of pancreas.
Indications : Type 2 diavetes militus.
Contra-indications: Hypersensitivity, diabetic ketoacidosis, with or without coma, type 1 diabetes.
Special Precautions: Hypoglycaemia : Proper patient selection, dosage, and instructions to the patients are important. Hypoglycemia is more likely to occur in patients with hepatic insufficiency, when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used. Loss of control of blood glucose may occur when a patient stablized on any diabetic regimen is exposed to stress such as fever, trauma, infection or srugery. At such times, discontinue repglinide and administer insulin.
Dosage: Repaglinide may be administered varying from immediately preceding the meal to as long as 30 minutes before the meal.
Initial dose: For patients not previously treated with OHA or whose HbA10 is <8%, the starting dose should be0.5mg. For patients preciously treated with bloo glucose-lowering drugs or whose HbA10 is> 8%, the starting dose is 1 or 2 mg with each meal preprandially.
Maintenance dose: Depending on response the dose may be titrated from 0.25mg upto 4 mg preprandially until staisfactory respone is achleved. At least one week should elapase to asses reponse after each dose adjustmetn. The recommended dose range is 0.5 mg to 4mg taken preceding each meal, Repaglinide may be closed preprandially 2,3, patient’s meal pattern. The maximum recommended daily dose is 16mg. In case of hepatic insufficiency an inital 0.25mg dose is recommended.
Side-effects: Mild or moderate hypoglcaemia. URTIs, nausea, vomiting, arthralgia, back pain, and headache.
Drug Interactions: Ketoconazole, miconazole and erythromycin : metabolism of repaglinide inhibited. Taroglitazone, fiampicin, barbiturates, and carbamazepine : Increase metabolism of repaglinide