Nateglinide (Oral)

Overview

Nateglinide is a prescription-only medication marketed under the brand name Starlix that is intended for the treatment of high blood sugar associated with diabetes mellitus. It treats the body's inability to produce and move insulin produced by the pancreas to regulate the sugar in the bloodstream and other cells in the body. It is often used in combination with other medications (including metformin and thiazolidinedione) to lower blood sugar and help restore the body's ability to use food to make energy. While many patients are able to control their diabetes through changes to diet and exercise, Nateglinide is intended for those who may have physical challenges or disability that are a barrier to sufficient physical activity. The amount prescribed may vary based on the amount of physical activity that the patient is able to perform. Regular testing of the blood sugar is necessary when there are changes to activity or diet. Failure to do so may result in insufficient treatment for high blood sugar or excessively low blood sugar as the body corrects to the medication. Nateglinide works best as part of a comprehensive structured diet and exercise program to treat this chronic condition.

It is important to note that nateglinide is not intended to treat patients with insulin-dependent Type I Diabetes because they have an inability to produce insulin from the pancreas and injections of insulin is the proper treatment for this kind of condition. The medication also may have a limited or nonexistent effect on the wellbeing of patients who have been treated with other antidiabetic agents for a long period of time. If other antidiabetic medications such as metformin or thiazolidinedione are taken prior to nateglinide, it should be prescribed as a supplemental treatment and not a replacement. As with many medications in this class of medicine, there may be significant risks of side effect and drug interactions that will affect the decision of a physician to use this drug to treat diabetes.

Condition Treated

  • Type II Diabetes Mellitus

Type Of Medicine

  • Antidiabetic agent

Side Effects

Nateglinide may induce some side effects, along with its intended purpose of treating high blood sugar, and although not all patients will be affected by these side effects there are certain effects which will be severe enough to warrant medical attention. If any of the following severe side effects occur, emergency medical attention should be sought immediately:

  • Convulsions
  • Seizures
  • Unconsciousness

This medication may induce a side effect that actually results in low blood sugar rather than correcting the problem and this will induce a number of effects including:

  • Anxious feeling
  • Behavior change/drunken behavior
  • Blurred vision
  • Cold sweats
  • Confusion
  • Cool pale skin
  • Difficulty in thinking
  • Drowsiness
  • Excessive hunger
  • Fast heartbeat
  • Headache
  • Nausea
  • Nervousness
  • Nightmares
  • Restless sleep
  • Shakiness
  • Slurred speech
  • Unusual tiredness or weakness

Some of the less commonly observed but nonetheless serious side effects of Nateglinide include:

Not all of the side effects of nateglinide are considered serious and some are temporary in nature. These effects will fade away as the body gets used to taking the medication.

Temporary side effects of nateglinide may include:

  • Cough
  • Runny or stuffy nose
  • Sore throat
  • Abdominal or stomach pain
  • Back pain
  • Chills
  • Dizziness
  • Pain in joints or muscles
  • Sneezing
  • Swelling in joints

If these side effects last longer than is expected or are more severe in nature, they should be reported to a medical professional as they may be indicative of a more serious health condition.

Dosage

The dosage of nateglinide prescribed will depend on a number of factors, including a strict diet plan provided by the prescribing physician. This special meal plan needs to be followed along with any instructions of regular exercise. Blood and urine tests will be regularly performed to determine how well the medication is working and adjust the dose accordingly. Due to the nature of how this medication works, it will need to be taken between one hour and 30 minutes before a meal. If a meal is skipped for any reason than the scheduled dose of nateglinide needs to be skipped as well.

Nateglinide needs to be strictly used as directed and not a remedy if a patient is feeling any signs of high blood sugar. The intention of this prescription is to help regulate the amount of sugar in the blood and aid the body in creating and using its own insulin. Likewise, even if blood sugar equilibrium is attained, this medication - or others like it - may need to be taken for the rest of a patient's life to maintain their health. Failure to take this medication as directed can lead to many of the serious problems associated with high blood sugar, including blood vessel disease, kidney disease, or even heart failure.

The dose of nateglinide necessary to regulate blood sugar will depend on a number of factors including the age and weight of the patient, as well as the severity of their diabetic condition. Prescription directions should be followed exactly and the average recommended dose may not apply to every patient. The strength of the dose and the number of doses taken each day may be adjusted to account for the particular state of the patient and where they are in the plan to treat their diabetes.

When taken in oral form for the treatment of type II diabetes, nateglinide tablets will be taken in 60 to 120mg doses three times per day. These doses should only be taken with meals and should not be taken if a meal is going to be skipped. Children who suffer from type II diabetes may be prescribed this medication only under the strict supervision of a pediatrician. If a dose is missed it can be taken between one hour and 30 minutes of the next main meal that the patient will be eating. It may be necessary to carefully regulate meal schedules and space them out throughout the day as doses too close together during the course of a day may result in a potentially serious overdose. If a dose is missed, under no circumstances is a double dose to be taken.

Interactions

Some drugs used at the same time as nateglinide may have interactions that produce undesirable conditions and are not recommended to be used together. Because of the potential for these conditions to arise when combining drug treatments, it is very important that the prescribing physician knows all medications that the patient is taking whether it is prescription or nonprescription. There are a number of medications which may adversely react to nateglinide and the following list included the most notable and serious cases of drug interactions.

The following medications are known to react poorly with nateglinide and are not recommended to be used together but may represent the best possible treatment depending on the patient's condition:

  • Aspirin
  • Balofloxacin
  • Besifloxacin
  • Ceritinib
  • Ciprofloxacin
  • Conivaptan
  • Enoxacin
  • Entacapone
  • Fleroxacin
  • Flumequine
  • Gatifloxacin
  • Gemifloxacin
  • Idelalisib
  • Lanreotide
  • Levofloxacin
  • Lomefloxacin
  • Metreleptin
  • Moxifloxacin
  • Nadifloxacin
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Pasireotide
  • Pazufloxacin
  • Pefloxacin
  • Prulifloxacin
  • Rufloxacin
  • Simeprevir
  • Sparfloxacin
  • Thioctic Acid
  • Tosufloxacin

There are also some medications that have been shown to have an increased risk of certain side effects of one or both medications when used together with nateglinide:

  • Acebutolol
  • Atenolol
  • Betaxolol
  • Bisoprolol
  • Bitter Melon
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Eltrombopag
  • Esmolol
  • Furazolidone
  • Glucomannan
  • Guar Gum
  • Iproniazid
  • Isocarboxazid
  • Labetalol
  • Levobunolol
  • Linezolid
  • Methylene Blue
  • Metipranolol
  • Metoprolol
  • Moclobemide
  • Nadolol
  • Nebivolol
  • Nialamide
  • Oxprenolol
  • Penbutolol
  • Phenelzine
  • Pindolol
  • Practolol
  • Procarbazine
  • Propranolol
  • Psyllium
  • Rasagiline
  • Safinamide
  • Selegiline
  • Sotalol
  • Timolol
  • Tranylcypromine

It is necessary to use the preceding medications with nateglinide for the good of the patient then precautions should be taken including changing doses of one or both medications or changing how often the drugs are used. Patients using these medications together should be closely monitored and tested regularly to ensure the medications are working as intended.

Nateglinide is not known to react to particular food or drink but caution must be taken with alcohol or tobacco use and neither are recommended. Additionally, consuming certain kinds of food or food in excessive quantities may defeat the purpose of the medication. Detailed dietary guidelines will be provided with the directions on using this medication and should be followed closely. It is of note that while regular physical exercise and diet are an important part of a treatment plan with this medication, excessive exercise or a diet more strict than is determined by the prescribing physician may result in serious health problems.

Certain medical conditions a patient has other than diabetes will have an effect on how well nateglinide works for them. Whether these are current conditions or the patient has a history of them, they need to be taken into account before prescribing nateglinide. These conditions include:

  • Adrenal gland conditions
  • Pituitary gland conditions
  • Hormonal imbalance
  • Malnourishment
  • Severe kidney problems
  • Alcoholism
  • Anorexia
  • Fever
  • Infection
  • Surgery
  • Trauma
  • Diabetic ketoacidosis
  • Type I diabetes
  • Liver Disease
  • Nervous system disorders

Warnings

When taking nateglinide the patient will need to regularly visit their doctor to monitor their progress and make sure that the medication is working as it is intended to. This is especially important during the first few weeks of taking the medication, but these visits will be required for as long as the medication is taken. Strict directions regarding use of this medication from the prescribing physician need to be followed and failure to do so may result in this medication being an ineffective treatment of diabetes.

Patients who are using nateglinide should not drink alcohol as this may result in severe low blood sugar. As there are a number of medications that have adverse reactions with nateglinide it is very important that all medication that is being taken is discussed with a doctor prior to prescribing this drug. Of note are over-the-counter medications intended for the treatment of seasonal allergies, asthma, coughs, colds, sinus problems, or pain relief. Nonprescription medication intended as an appetite suppressor may create a dangerous condition if used at the same time as nateglinide.

Use of this medication may necessitate a high degree of counseling of both patients and family members in its use, prevention of side effects, and dealing with medical emergencies associated with high or low blood sugar. Changes in exercise or diet may result in the need to change dosages, so these changes should be reported to a medical professional as they occur. Women who take nateglinide will need to be counseled regarding the complications that can result from diabetes during pregnancy and steps that can be taken to prevent them or minimize the chances that they will occur. When traveling, patients who are taking nateglinide will need to carry their most recent prescription and a medical history in case of an emergency. When changing time zones during travel, care should be taken not to miss mealtimes or doses of medication and both should be taken as close as possible as mealtimes in the normal time zone would be.

Due to the nature of type II diabetes, a patient taking nateglinide should be prepared to call for emergency help if there is any problem caused by high or low blood sugar. It is recommended that the patient wear medical identification bracelets or neck chains at all times in case of loss of consciousness. Carrying appropriate emergency medical identification that includes a list of all medication taken will be essential if there is ever a situation where the patient is unresponsive or unable to respond to questions.

One of the more serious conditions that nateglinide can cause when not used as directed is hypoglycemia. This low blood sugar can occur for a number of reasons including drinking alcohol, missing meals, engaging in excessive exercise, or vomiting. This condition must be treated immediately because it can lead to a loss of consciousness or even death. Knowing the warning signs of low blood sugar and how to treat them as they occur can help keep the patient out of the emergency room. These symptoms include weakness, fatigue, slurred speech, trembling, sleeplessness, nightmares, nervous condition, nausea, headaches, rapid heartbeat, excessive hunger, drowsiness, difficulty concentrating, pale skin, confusion, cold sweat, and blurred vision. In some cases, a patient suffering from low blood sugar may feel like they are drunk or intoxicated.

If any of the above symptoms of low blood sugar occur there are certain steps that should be taken to arrest them and make sure that they don't get worse. The prescribing physician may provide glucose tablets for these situations but if they are not available certain food and drink may be substituted. Corn syrup, fruit juice, sugar cubes, honey, sugar in water, or nondiet soda are quick ways to treat this condition. However, if these attempts to raise blood sugar do not alleviate the symptoms then emergency medical services should be called immediately. Emergency help should also be called for if any severe symptoms such as seizures or loss of consciousness occur. Food or drink should not be forced on an unresponsive or unconscious patient because there is a risk of asphyxiation or choking on the food or beverage.

There are a number of dangerous activities that can result in high blood sugar while taking this medication, including skipping doses, overeating, or lack of exercise. Fevers and infections may increase the likelihood of this condition. Symptoms of hyperglycemia include unusual thirst, loss of consciousness, difficulty breathing, fatigue, exhaustion, vomiting, nausea, stomachache, loss of appetite, increased urination, fruit-like odor on the breath, dry skin, flushed complexion, dry mouth, drowsiness, and blurred vision.

Symptoms of high blood sugar include blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination; ketones in urine; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; or unusual thirst. If any of these symptoms are noticed blood pressure should be taken immediately before calling a doctor for further instructions.

Storage

Nateglinide needs to be securely stored away from the reach of children or others it is not intended for. It can be extraordinarily dangerous to people with normal blood sugar levels. It needs to be stored at room temperature away from sources of heat, freezing cold, or direct light. It is best to keep it in its original container or a similar secure container. If it is no longer needed or has expired it should be disposed of in accordance with local guidelines for disposing of medical waste.

Summary

Nateglinide is a potentially lifesaving treatment for people who have more severe cases of type II diabetes, but it must be used only with significant caution as a result of its potential for side effects, detrimental drug interactions, and the consequences of misuse. While it can effectively treat high blood sugar levels, it is important to note that it is not a cure for diabetes. Rather, it is a way to maintain relative health even though the patient is inflicted with this condition. Nateglinide alone is not normally considered as an appropriate treatment for diabetic patients, but rather is used with other medications as a part of a comprehensive treatment plan. If a patient does not communicate with their doctor regularly regarding changes to their diet, activity level, or health severe conditions can result from noncompliance with the overall treatment plan. If used as directed and as a part of a plan that integrated nutritional and physical activity solutions, this medication can be a very effective aid in managing the blood sugar levels of patients who are suffering from with diabetes mellitus.