repaglinide

CLINICAL USE

Type 2 diabetes mellitus

DOSE IN NORMAL RENAL FUNCTION

0.5–16 mg daily, doses given 15–30 minutes before a meal; doses up to 4 mg can be given as a single dose

PHARMACOKINETICS

Molecular weight :452.6

%Protein binding :>98

%Excreted unchanged in urine : <8 (mainly as metabolites)

Volume of distribution (L/kg) :30 litres

half-life – normal/ESRD (hrs) :1/2

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–80 Dose as in normal renal function5–29 Start at a low dose and gradually increase according to response<5 Start at a low dose and gradually increase according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR<5 mL/min.

HD :Not dialysed. Dose as in GFR<5 mL/min.

HDF/high flux :Not dialysed. Dose as in GFR<5 mL/min.

CAV/VVHD :Unlikely to be dialysed. Dose as in GFR=5–29 mL/min.

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antibacterials: effects enhanced by clarithromycin and possibly trimethoprim; hypoglycaemic effect antagonised by rifampicin

Antifungals: effect possibly enhanced by itraconazole

Ciclosporin: possibly enhanced hypoglycaemic effectLipid-lowering agents: increased risk of severe hypoglycaemia with gemfibrozil – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Major route of elimination is hepatic metabolism to inactive metabolites which are excreted via the bile.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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