Prandin: Rapid Post-Meal Blood Glucose Control for Type 2 Diabetes
Prandin
| Product dosage: 1mg | |||
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| Product dosage: 2mg | |||
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Synonyms | |||
Prandin (repaglinide) is a rapid-acting meglitinide-class oral antidiabetic agent indicated for the management of hyperglycemia in type 2 diabetes mellitus. It functions as a short-acting insulin secretagogue, stimulating the release of insulin from functional pancreatic beta cells in response to meals. This medication is designed to be taken with main meals to specifically target postprandial glucose excursions, offering a flexible dosing regimen that aligns with variable meal patterns. Prandin is typically prescribed as an adjunct to diet and exercise, and may be used as monotherapy or in combination with other glucose-lowering agents like metformin when glycemic targets are not achieved with single-agent therapy. Its pharmacokinetic profile allows for precise mealtime glucose management with a reduced risk of prolonged hypoglycemia between meals.
Features
- Contains repaglinide as the active pharmaceutical ingredient
- Available in 0.5 mg, 1 mg, and 2 mg oral tablets
- Rapid onset of action (approximately 30 minutes)
- Short duration of effect (approximately 3-4 hours)
- Renal excretion is minimal (<8%), making it suitable for patients with renal impairment
- Primarily metabolized by the liver via CYP3A4 and CYP2C8 enzymes
- White to off-white, round, flat-faced tablets with beveled edges
Benefits
- Provides targeted control of postprandial blood glucose spikes
- Offers flexible dosing that can be adjusted according to meal patterns
- Reduces hemoglobin A1c levels by addressing meal-related glucose excursions
- Lower risk of between-meal hypoglycemia compared to longer-acting secretagogues
- Suitable for patients with irregular eating schedules
- Can be used in patients with renal impairment when other options are limited
Common use
Prandin is primarily prescribed for adults with type 2 diabetes mellitus who have inadequate glycemic control despite diet and exercise modifications. It is particularly beneficial for patients who experience significant postprandial hyperglycemia and those with irregular meal patterns. The medication is often used when metformin is contraindicated or not tolerated, or as add-on therapy when metformin alone provides insufficient glycemic control. Clinical studies have demonstrated its efficacy in reducing both fasting and postprandial glucose levels, with A1c reductions typically ranging from 0.5% to 2.0% depending on baseline levels and concomitant therapies.
Dosage and direction
The recommended starting dose is 0.5 mg taken within 30 minutes before each main meal. Patients who have previously taken other glucose-lowering agents may begin with 1 mg or 2 mg preprandially. The dose may be titrated at weekly intervals based on blood glucose monitoring, with maximum recommended single dose of 4 mg and maximum daily dose of 16 mg. Dosing should be individualized according to metabolic needs, meal patterns, and glycemic response. If a meal is skipped, the corresponding dose of Prandin should be omitted to prevent hypoglycemia. The medication should be swallowed whole with water and not crushed or chewed.
Precautions
Patients should be advised to maintain regular meal patterns to avoid hypoglycemia. Hepatic function should be monitored periodically, as impaired liver function may affect drug metabolism and increase hypoglycemia risk. Elderly patients and those with adrenal or pituitary insufficiency may be more susceptible to hypoglycemia. Patients should be educated about recognizing and managing hypoglycemic symptoms. Prandin should be used with caution in malnourished patients or those with irregular food intake. Regular monitoring of glycemic control including hemoglobin A1c is recommended every 3 months initially, then as clinically indicated.
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 diabetic ketoacidosis. Concomitant use with gemfibrozil is absolutely contraindicated due to significant drug interaction that dramatically increases repaglinide exposure. The medication is contraindicated in combination with other potent CYP2C8 inhibitors unless close monitoring and dose adjustment are implemented.
Possible side effect
The most common adverse reaction is hypoglycemia, which may occur in up to 16% of patients. Other reported side effects include headache (11%), upper respiratory infection (10%), sinusitis (6%), arthralgia (5%), and nausea (5%). Less frequent adverse effects include diarrhea, constipation, back pain, chest pain, and allergic skin reactions. Severe hypoglycemia requiring assistance occurs in approximately 2-4% of patients. Elevated liver enzymes have been reported in some cases, though causal relationship remains uncertain.
Drug interaction
Strong CYP2C8 inhibitors (gemfibrozil, clopidogrel) significantly increase repaglinide plasma concentrations and are contraindicated. Moderate CYP2C8 inhibitors (trimethoprim) may require dose adjustment. CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin) can increase repaglinide levels. Inducers of CYP3A4 (rifampin, barbiturates, carbamazepine) may decrease efficacy. Beta-blockers may mask hypoglycemic symptoms. NSAIDs, salicylates, sulfonamides, and MAO inhibitors may enhance hypoglycemic effect. Thiazides, corticosteroids, phenothiazines, thyroid products, and estrogens may reduce hypoglycemic effect.
Missed dose
If a dose is missed before a meal, it should be omitted entirely. The patient should not take a double dose to make up for the missed dose. The next dose should be taken as scheduled with the next main meal. Patients should be advised to check their blood glucose if they suspect hypoglycemia symptoms after missing a dose, particularly if they consumed a meal without medication.
Overdose
Overdose may manifest as severe hypoglycemia with symptoms including confusion, tremors, sweating, palpitations, visual disturbances, and possible loss of consciousness. Management consists of immediate glucose administration (oral dextrose for conscious patients, intravenous glucose or glucagon injection for unconscious patients). Patients should be monitored for at least 24-48 hours as hypoglycemia may recur. Hospitalization may be required for severe cases. There is no specific antidote for repaglinide overdose.
Storage
Store at 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 in the original container with the lid tightly closed to protect from moisture. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Protect from light and excessive heat.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional based on individual patient characteristics. The prescribing physician should be familiar with complete prescribing information including boxed warnings. Patients should not adjust their medication regimen without medical supervision. Actual clinical effects may vary among individuals.
Reviews
Clinical trials demonstrate that Prandin effectively reduces postprandial glucose excursions with mean A1c reductions of 1.5-2.0% in treatment-naïve patients. In comparative studies, Prandin showed similar efficacy to sulfonylureas with potentially lower risk of severe hypoglycemia. Patient satisfaction surveys indicate appreciation for the flexible dosing schedule, though some report inconvenience of multiple daily dosing. Real-world evidence suggests good tolerability profile with discontinuation rates due to adverse effects below 5%. Long-term observational studies show maintained efficacy over 12-24 months of treatment when combined with lifestyle modifications.