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 meglitinide-class oral antidiabetic agent specifically designed to address postprandial hyperglycemia in patients with type 2 diabetes mellitus. By stimulating insulin secretion from pancreatic beta cells in a glucose-dependent manner, it offers a targeted therapeutic approach that aligns closely with meal patterns. Its pharmacokinetic profile—characterized by rapid absorption, short onset of action, and brief duration—makes it particularly suitable for individuals with irregular meal schedules or those who experience significant glycemic excursions after eating. Clinical evidence supports its efficacy in reducing HbA1c levels when used as monotherapy or in combination with other glucose-lowering agents, providing a flexible option within a comprehensive diabetes management plan.
Features
- Contains repaglinide as the active pharmaceutical ingredient
- Available in 0.5 mg, 1 mg, and 2 mg oral tablets
- Rapid onset of action: begins working within 30 minutes of administration
- Short duration of effect: approximately 3–4 hours
- Administered preprandially, typically 15–30 minutes before meals
- Metabolized primarily via CYP3A4 and CYP2C8 hepatic enzymes
- Excreted predominantly through bile into feces
- Does not accumulate in patients with renal impairment
Benefits
- Effectively lowers postprandial glucose spikes by stimulating rapid insulin release
- Flexible dosing schedule that can be adjusted based on meal frequency and timing
- Reduced risk of between-meal hypoglycemia compared to longer-acting secretagogues
- Suitable for patients with renal impairment where other antidiabetics may be contraindicated
- Can be used as monotherapy or in combination with metformin or thiazolidinediones
- Provides glycemic control without weight gain associated with some other antidiabetic classes
Common use
Prandin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is particularly appropriate for patients who experience significant postprandial hyperglycemia and those with irregular eating patterns. The medication is often prescribed when metformin alone provides insufficient glycemic control or when metformin is contraindicated due to gastrointestinal intolerance or renal considerations. Clinical studies have demonstrated its effectiveness in reducing HbA1c levels by 1.5–2.0% when used as monotherapy, with additional reductions when combined with other antidiabetic agents.
Dosage and direction
The recommended starting dose is 0.5 mg taken 15–30 minutes before each main meal. Patients who have previously used another oral hypoglycemic agent may begin with 1–2 mg preprandially. Dosage should be individualized based on glycemic response and meal patterns, with a maximum recommended dose of 16 mg per day. The dosing frequency should correspond to the number of meals consumed daily—if a meal is skipped, the corresponding dose should be omitted. Dose titration should occur at weekly intervals based on self-monitored blood glucose measurements, particularly postprandial values. Patients transferring from other oral hypoglycemic agents should discontinue the previous medication and begin Prandin therapy at the recommended starting dose.
Precautions
Patients should be advised that Prandin may cause hypoglycemia, particularly when meals are delayed, skipped, or inadequate in carbohydrate content. Renal function should be monitored periodically, as severe renal impairment may increase repaglinide exposure. Hepatic impairment requires careful dose titration due to reduced metabolism and clearance. Elderly patients and those with adrenal or pituitary insufficiency may be more susceptible to hypoglycemic effects. Patients should be educated about recognizing and managing hypoglycemia, including carrying glucose tablets or other rapid-acting carbohydrates. Concomitant illnesses, fever, trauma, or surgery may require temporary insulin therapy. Regular monitoring of hepatic enzymes is recommended during treatment.
Contraindications
Prandin is contraindicated in patients with known hypersensitivity to repaglinide 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 absolutely contraindicated due to significantly increased repaglinide exposure and severe hypoglycemia risk. The medication is contraindicated in combination with clarithromycin, ketoconazole, itraconazole, and other potent CYP3A4 inhibitors that significantly increase repaglinide plasma concentrations. Use during pregnancy is contraindicated unless potential benefit justifies potential risk to the fetus.
Possible side effects
The most common adverse reaction is hypoglycemia, occurring in approximately 16–31% of patients depending on combination therapy and dose. Other reported side effects include headache (11%), rhinitis (10%), sinusitis (6%), arthralgia (5%), constipation (5%), diarrhea (4%), dyspepsia (4%), back pain (4%), paresthesia (3%), and upper respiratory infection (3%). Less frequent adverse reactions include nausea, vomiting, allergic skin reactions, visual disturbances, and elevated liver enzymes. Severe hypoglycemia requiring assistance occurs in approximately 2–4% of patients, particularly those attempting intensive glycemic control or with irregular meal patterns. Cardiovascular events occur at rates comparable to other oral antidiabetic agents.
Drug interaction
Prandin exhibits significant interactions with medications affecting CYP3A4 and CYP2C8 enzymes. Gemfibrozil increases repaglinide exposure by 8-fold and is absolutely contraindicated. CYP3A4 inhibitors including ketoconazole, itraconazole, clarithromycin, and ritonavir significantly increase repaglinide levels. CYP3A4 inducers such as rifampin, barbiturates, and carbamazepine may decrease repaglinide efficacy. Beta-blockers may mask hypoglycemic symptoms. NSAIDs, salicylates, sulfonamides, and MAO inhibitors may potentiate hypoglycemic effects. Thiazides, corticosteroids, phenothiazines, thyroid products, and estrogens may reduce hypoglycemic effectiveness. Close monitoring is required when initiating or discontinuing concomitant medications.
Missed dose
If a dose is missed and the next meal is more than 30 minutes away, the patient should take the missed dose immediately. If the next meal is within 30 minutes, the missed dose should be skipped and the regular schedule resumed with the next meal. Patients should never double the dose to make up for a missed tablet. Blood glucose should be monitored more frequently following a missed dose, as hyperglycemia may occur. The management of missed doses should be individualized based on the patient’s typical glycemic patterns and meal schedule.
Overdose
Overdose of Prandin may produce severe hypoglycemia requiring immediate medical attention. Symptoms include confusion, palpitations, sweating, tremor, visual disturbances, and loss of consciousness. Management includes immediate administration of oral carbohydrates for conscious patients or intravenous glucose/dextrose for unconscious patients. Continuous glucose monitoring is essential, as hypoglycemia may recur due to the medication’s duration of action. In cases of massive overdose, hospitalization with prolonged glucose administration and monitoring may be necessary. There is no specific antidote for repaglinide overdose. Dialysis is not effective due to high protein binding.
Storage
Store Prandin tablets at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use tablets that are discolored or show signs of deterioration. Properly discard expired or unused medication through medication take-back programs or according to local regulations. Do not flush medications down the toilet or pour into drains unless specifically 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 complete information regarding indications, dosage, warnings, and precautions. Patients should not alter their treatment regimen without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves and this information may not reflect the most current research or recommendations.
Reviews
Clinical trials demonstrate that Prandin effectively reduces HbA1c by 1.5–2.0% with flexible dosing appreciated by patients with irregular meal patterns. Endocrinologists note its particular value in targeting postprandial hyperglycemia without prolonged hypoglycemia risk. Some patients report satisfaction with the ability to adjust dosing based on meal content and timing. Criticism primarily focuses on the multiple daily dosing requirement and potential for hypoglycemia if meals are missed. Comparative studies show similar efficacy to other secretagogues with possibly better tolerability in renal impairment. Long-term cardiovascular safety data remain limited compared to newer antidiabetic classes.